Provider Demographics
NPI:1578387338
Name:CLARK, HALEY ANN (LCMFT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 IDLEOAK CT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1669
Mailing Address - Country:US
Mailing Address - Phone:714-403-1523
Mailing Address - Fax:
Practice Address - Street 1:409 IDLEOAK CT
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1669
Practice Address - Country:US
Practice Address - Phone:714-403-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist