Healthcare Provider Details

I. General information

NPI: 1942113063
Provider Name (Legal Business Name): DANA CLARK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S RAILROAD AVE
ASHLAND VA
23005-2076
US

IV. Provider business mailing address

453 RIVANNA HILL RD
GLEN ALLEN VA
23060-4062
US

V. Phone/Fax

Practice location:
  • Phone: 804-412-8617
  • Fax:
Mailing address:
  • Phone: 804-412-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701014741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: