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General NPI Number Information
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NPI Number | 1538610233
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Entity Type | Individual
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Provider Name | HEATHER E CLARK LPC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 700 MELVIN AVE SUITE 5
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1514
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Country | US
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Telephone | 410-280-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 HUIDEKOPER PL NW
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City | WASHINGTON
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State | DC
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Zip | 20007-1827
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Country | US
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Telephone | 202-556-4435
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Fax | 202-554-9456
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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 | LC10902
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | TPMC4050
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PRC200001306
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701011991
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License Number State | VA
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