Provider Demographics
NPI:1871825919
Name:CLARKE-DANIEL, AYANNA KEMBA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AYANNA
Middle Name:KEMBA
Last Name:CLARKE-DANIEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1460
Mailing Address - Country:US
Mailing Address - Phone:678-438-3644
Mailing Address - Fax:
Practice Address - Street 1:3505 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1460
Practice Address - Country:US
Practice Address - Phone:678-438-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional