Provider Demographics
NPI:1477679462
Name:CLARK, JAMIE (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351C JAYCEE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2997
Mailing Address - Country:US
Mailing Address - Phone:717-657-2080
Mailing Address - Fax:717-657-2290
Practice Address - Street 1:4 SHARON RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1823
Practice Address - Country:US
Practice Address - Phone:717-728-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor