Provider Demographics
NPI:1922413004
Name:A. LISA CLARK COUNSELING, LLC
Entity Type:Organization
Organization Name:A. LISA CLARK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC-CS
Authorized Official - Phone:216-346-7692
Mailing Address - Street 1:433 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6797 N HIGH ST
Practice Address - Street 2:STE 223
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:614-885-0891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty