Provider Demographics
NPI:1518394576
Name:CLARKE, ERICA LEATRICE (MSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEATRICE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 SPRING RD NW
Mailing Address - Street 2:B1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1225
Mailing Address - Country:US
Mailing Address - Phone:202-413-6358
Mailing Address - Fax:
Practice Address - Street 1:1437 SPRING RD NW
Practice Address - Street 2:B1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1225
Practice Address - Country:US
Practice Address - Phone:202-413-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
DCLG50078095104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral