Clark, Aletha Jennifer

Clark, Aletha Jennifer is an individual health care provider with primary practice located at 2386 Clower St Ste D-100 , Snellville GA 30078-6134. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Clark, Aletha Jennifer can be contacted via phone (404) 550-0564.

Contact Information

Primary practice address
2386 Clower St Ste D-100 Snellville GA 30078-6134
Phone: (404) 550-0564
Fax: (678) 344-2956
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1658-R Georgia
Behavioral Health & Social Service Providers / Professional 101YP2500X LPC004805 Georgia

Profile Details

NPI number 1912049594
LBN Legal business name Clark, Aletha Jennifer
Credentials PHD, LPC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 12th, 2007
Last updated Feb 6th, 2024 - about 9 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912049594 NPPES
Georgia MEDICAID 894502453A

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