Healthcare Provider Details

I. General information

NPI: 1447924949
Provider Name (Legal Business Name): WHITTNEY ELISE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CLARENDON BLVD STE 115
ARLINGTON VA
22209-2700
US

IV. Provider business mailing address

15312 WITS END DR
WOODBRIDGE VA
22193-5889
US

V. Phone/Fax

Practice location:
  • Phone: 703-498-2054
  • Fax:
Mailing address:
  • Phone: 901-573-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAAC-15603
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: