Provider Demographics
NPI:1306926381
Name:CLARK, LEIGH ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LEIGH ANNE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LEIGH ANNE
Other - Middle Name:
Other - Last Name:MURTAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:124 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4204
Mailing Address - Country:US
Mailing Address - Phone:404-281-3855
Mailing Address - Fax:
Practice Address - Street 1:124 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4204
Practice Address - Country:US
Practice Address - Phone:404-281-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003971101Y00000X
NJ44SL05284800104100000X
NJ44SC05317700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker