Provider Demographics
NPI:1437443009
Name:CLARK, KATIE FITE (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:FITE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:FITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC
Mailing Address - Street 1:2404 N ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1037
Mailing Address - Country:US
Mailing Address - Phone:843-340-6402
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4602
Practice Address - Country:US
Practice Address - Phone:703-281-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health