Provider Demographics
NPI:1649541723
Name:CLARK, ANN MORROW (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MORROW
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11214
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-1214
Mailing Address - Country:US
Mailing Address - Phone:803-448-0086
Mailing Address - Fax:803-526-7686
Practice Address - Street 1:830 N JONES AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4739
Practice Address - Country:US
Practice Address - Phone:803-448-0086
Practice Address - Fax:803-526-7686
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC5714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor