Clark, Molly

Clark, Molly is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has only one registered license in Behavioral Health & Social Service Providers / Counseling, which is considered as her primary health care specialty. Clark, Molly can be contacted via phone (601) 815-4778.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 815-4778
Fax: (601) 984-5420
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X
Behavioral Health & Social Service Providers / Counseling 103TC1900X 46810 Mississippi

Profile Details

NPI number 1992900591
LBN Legal business name Clark, Molly
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2007
Last updated Feb 13th, 2014 - about 11 years 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 1992900591 NPPES
Mississippi MEDICAID 01289231
Mississippi Other 302I681423

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