| Doctor Name: | ANNA LISA CLARK |
| NPI Number: | 1457376485 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW, LICDC |
| License Number: | I-0007941 |
| Business Practice Address: | 35888 Center Ridge Rd Suite 5 North Ridgeville, OH - 440393086 |
| Business Phone Number: | 4403271800 |
| Business Fax Number: | 4403271533 |
| Mailing Address: | 35888 Center Ridge Rd, Suite 5 NORTH RIDGEVILLE |
| State: | OH |
| Postal Code: | 440393086 |
| Phone Number: | 4403271800 |
| Fax Number: | 4403271533 |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-0007941 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |