Doctor Name: | MR. KELVIN D CLARK |
NPI Number: | 1033165923 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS, LMFT, LPC, LCAS |
License Number: | 448 |
Business Practice Address: | 1500 Bragg Blvd Fayetteville, NC - 283014289 |
Business Phone Number: | 9103231065 |
Business Fax Number: | 9103231144 |
Mailing Address: | 3805 Woodside Dr, SANFORD |
State: | NC |
Postal Code: | 273328110 |
Phone Number: | 9197760399 |
Fax Number: | 9103231144 |
NPI Enumeration Date: | 05/25/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 448 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |