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General NPI Number Information
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NPI Number | 1386344174
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Entity Type | Individual
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Provider Name | ANIKA CLARK
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Gender | Female
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1114 BENEFIELD BLVD SUITE G
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City | MILLERSVILLE
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State | MD
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Zip | 21108
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Country | US
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Telephone | 410-780-5203
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Fax |
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Provider Business Mailing Address
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Address Line | 15614 EVERGLADE LN APT 306
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City | BOWIE
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State | MD
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Zip | 20716-2254
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Country | US
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Telephone | 202-640-3222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 32291
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License Number State | MD
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