Provider Demographics
NPI:1902402290
Name:CLARK, ANNA S (MS)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:SKYE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8100
Mailing Address - Fax:
Practice Address - Street 1:203 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1665
Practice Address - Country:US
Practice Address - Phone:207-404-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TN6601101YP2500X
MECC7638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional