Provider Demographics
NPI:1619431632
Name:CLARK, ALIESHA YVONNE (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:ALIESHA
Middle Name:YVONNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 E MAIN ST STE 800
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 GRANITE DR
Practice Address - Street 2:
Practice Address - City:EAST EARL
Practice Address - State:PA
Practice Address - Zip Code:17519-9487
Practice Address - Country:US
Practice Address - Phone:717-543-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0250271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical