Provider Demographics
NPI:1275304313
Name:LEWIS-CLARKE, ANIKA
Entity Type:Individual
Prefix:MRS
First Name:ANIKA
Middle Name:
Last Name:LEWIS-CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 KELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3763
Mailing Address - Country:US
Mailing Address - Phone:404-992-5229
Mailing Address - Fax:
Practice Address - Street 1:2126 KELLINGTON DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3763
Practice Address - Country:US
Practice Address - Phone:404-992-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst