MEDICARE: ANN MORROW CLARK MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	5714	SC

General Provider Information

NPI Number	:	1649541723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MORROW CLARK MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 11214
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29731-1214
Country	:	US
Telephone Number	:	803-448-0086
Fax Number	:	803-526-7686

Provider Business Practice Location Address
First Line	:	830 N JONES AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4739
Country	:	US
Telephone Number	:	803-448-0086
Fax Number	:	803-526-7686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	02/09/2018

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