Provider Demographics
NPI:1265733521
Name:CLARK, CHRISTINA V (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:V
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-2003
Mailing Address - Country:US
Mailing Address - Phone:828-681-2837
Mailing Address - Fax:828-681-2837
Practice Address - Street 1:24 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2006
Practice Address - Country:US
Practice Address - Phone:828-681-2837
Practice Address - Fax:828-681-2837
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7926101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor