Provider Demographics
NPI:1528850385
Name:CLARK, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:CLARK
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 ORKNEY PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3829
Mailing Address - Country:US
Mailing Address - Phone:301-357-3446
Mailing Address - Fax:
Practice Address - Street 1:7090 SAMUEL MORSE DR STE 100-300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3442
Practice Address - Country:US
Practice Address - Phone:855-935-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst