Provider Demographics
NPI:1508210394
Name:CLARK, PATRICIA (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 LAUREL PT ISABEL RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:OH
Mailing Address - Zip Code:45153-9756
Mailing Address - Country:US
Mailing Address - Phone:513-519-4429
Mailing Address - Fax:
Practice Address - Street 1:1088 WASSERMAN WAY STE C
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1974
Practice Address - Country:US
Practice Address - Phone:513-735-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800303101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor