Provider Demographics
NPI:1487384491
Name:CLARK, JANAE (MHC)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCH
Mailing Address - Street 1:339 ARBOR RD SW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-8506
Mailing Address - Country:US
Mailing Address - Phone:404-801-1284
Mailing Address - Fax:
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:678-209-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC014627Medicaid
GAAPC007673Medicaid