Healthcare Provider Details

I. General information

NPI: 1720992910
Provider Name (Legal Business Name): ANSON LEIGH CLARK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N ST NW STE A1
WASHINGTON DC
20005-2817
US

IV. Provider business mailing address

209 INDIGO BAY CIR
MOUNT PLEASANT SC
29464-3973
US

V. Phone/Fax

Practice location:
  • Phone: 202-588-1112
  • Fax:
Mailing address:
  • Phone: 843-830-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-441674
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: