Provider Demographics
NPI:1538610233
Name:CLARK, HEATHER E (LPC, LCPC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 HUIDEKOPER PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1827
Mailing Address - Country:US
Mailing Address - Phone:202-556-4435
Mailing Address - Fax:202-554-9456
Practice Address - Street 1:700 MELVIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1514
Practice Address - Country:US
Practice Address - Phone:410-280-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10902101YM0800X
FLTPMC4050101YM0800X
DCPRC200001306101YM0800X
VA0701011991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health