Individual
DEREK ELLIS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4100 MONUMENT CT UNIT 204, FAIRFAX, VA 22033-2878
(571) 393-2424
Mailing address
4100 MONUMENT CT UNIT 204, FAIRFAX, VA 22033-2878
(703) 424-6788
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904013710
VA
Other
Enumeration date
02/14/2022
Last updated
11/17/2023
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