Provider Demographics
NPI:1386344174
Name:CLARK, ANIKA
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15614 EVERGLADE LN APT 306
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2254
Mailing Address - Country:US
Mailing Address - Phone:202-640-3222
Mailing Address - Fax:
Practice Address - Street 1:3705 W PICO BLVD # 640
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3451
Practice Address - Country:US
Practice Address - Phone:323-688-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health