Most Relevant Information
Provider Data
| NPI Number: | 1003298639 |
| Provider Name: | JEANETTA CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 101YS0200X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/19/2015 |
| Last Updated: | 06/19/2015 |
Provider Practice Location
1803 N. JACKSON ST
CENTERSTONE OF TENNESSEE
TULLAHOMA
TN
37388
Practice Location Phone/Fax
| Phone: | 6154636643 |
| Fax: |
Provider Mailing Location
3605 CHASEWOOD DR SW APT 5
HUNTSVILLE
AL
358055180
Provider Mailing Phone/Fax
| Phone: | 2054276509 |
| Fax: |