DEREK ELLIS CLARK

FAIRFAX, VA
NPI1710632278
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: VA  0904013710)
Enumeration Date2022-02-14
Last Update Date2023-11-17
Business Address
DEREK ELLIS CLARK LCSW
4100 MONUMENT CT UNIT 204
FAIRFAX, VA 22033-2878
Phone number: 571-393-2424
Mailing Address
DEREK ELLIS CLARK LCSW
4100 MONUMENT CT UNIT 204
FAIRFAX, VA 22033-2878
Phone number: 703-424-6788
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