| Doctor Name: | TANA L CLARKE |
| NPI Number: | 1053611749 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 04890 |
| Business Practice Address: | 1190 Winterson Rd Suite 160 Linthicum, MD - 210902209 |
| Business Phone Number: | 6315233453 |
| Business Fax Number: | |
| Mailing Address: | 1190 Winterson Rd, Suite 160 LINTHICUM |
| State: | MD |
| Postal Code: | 210902209 |
| Phone Number: | 6315233453 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2010 |
| NPI Last Update Date: | 01/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 04890 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |