Individual
ANITA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-S, LCSW
Contact information
Practice address
811 FALL PL, HERNDON, VA 20170-4107
(740) 361-5453
Mailing address
811 FALL PL, HERNDON, VA 20170-4107
(740) 361-5453
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904015851
VA
1041C0700X
Clinical Social Worker
I.2102854
OH
Other
Enumeration date
12/19/2022
Last updated
09/26/2024
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