Provider Demographics
NPI:1578456455
Name:CLARK, JAYLEN (MS, LGPC, NCC)
Entity type:Individual
Prefix:
First Name:JAYLEN
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:MS, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 WOODSDALE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3342
Mailing Address - Country:US
Mailing Address - Phone:443-955-2937
Mailing Address - Fax:
Practice Address - Street 1:621 WOODSDALE RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3342
Practice Address - Country:US
Practice Address - Phone:443-955-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health