Provider Demographics
NPI:1952865644
Name:CLARK, NAKIA SHANTHANEE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:NAKIA
Middle Name:SHANTHANEE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POST OFFICE RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2726
Mailing Address - Country:US
Mailing Address - Phone:301-302-0227
Mailing Address - Fax:
Practice Address - Street 1:2 POST OFFICE RD STE 1B
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2726
Practice Address - Country:US
Practice Address - Phone:301-302-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD240711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical