Annie Clark | Oakland, CA • PECOS Search

Annie Clark

Counselor

Behavioral Health & Social Service Providers

3408 Andover St, Oakland, CA 94609-2817

PECOS Enrollment

Based on the most recent information from CMS, provider Annie Clark does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1902478662
Provider Type
Individual
Full Name
Clark, Annie
Title
Ms.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
7/13/2021
Last Updated
7/13/2021

Contact Information

Practice Location

3408 Andover St, Oakland, CA 94609-2817

Unlisted Fax

Mailing Location

2000 Camanche Rd Spc 71, Ione, CA 95640-9428

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YA0400X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer