Provider Demographics
NPI:1245603489
Name:CLARK, MEAGAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MEAGAN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEW JERSEY AVE SE
Mailing Address - Street 2:APT 1114
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3312
Mailing Address - Country:US
Mailing Address - Phone:586-556-0014
Mailing Address - Fax:
Practice Address - Street 1:138 12TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6471
Practice Address - Country:US
Practice Address - Phone:586-556-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical