MR. KELVIN D CLARK (NPI# 1033165923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033165923 |
| Entity Type | Individual |
| Full Name | MR. KELVIN D CLARK |
| Credential | MS, LMFT, LPC, LCAS |
| Practice Address |
1500 Bragg Blvd Fayetteville NC 28301-4289 |
| Mailing Address |
3805 Woodside Dr Sanford NC 27332-8110 |
| Practice Telephone | 9103231065 |
| Practice Fax Number | 9103231144 |
| Mailing Telephone | 9197760399 |
| Mailing Fax Number | 9103231144 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101Y00000X | Counselor | 448 | NC | Behavioral Health & Social Service Providers |
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
NC | Behavioral Health & Social Service Providers | |
| X | 106H00000X | Marriage & Family Therapist | 448 | NC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | UNITED HEALTHCARE | 14762257 | 01 |
| NC | BLUE CROSS PROVIDER | 1002X | 01 |
| NC | CAQH | 11367606 | 01 |
| NC | 6102267 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093168452 | Kelvin Clark | Driver | 4712 Bass Dr, Holly Hill, SC 29059-8812 | 2016-07-20 |
| Street Address |
1500 BRAGG BLVD |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28301-4289 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588661441 | Carolyn Marak Carpenter | Social Worker | 1500 Bragg Blvd, Ste 201, Fayetteville, NC 28301-4289 | 2005-07-06 |
| 1750520581 | Mary Simmons Kinder | Counselor | 1500 Bragg Blvd, Fayetteville, NC 28301-4889 | 2009-02-18 |
| 1710145875 | Pathways To Empowerment Counseling Center | Counselor | 1500 Bragg Blvd, Fayetteville, NC 28301-4889 | 2008-05-27 |
| 1932188117 | Alfred Peuster | Marriage & Family Therapist | 1500 Bragg Blvd, Suite 105, Fayetteville, NC 28301-4289 | 2006-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726219 | Jenna Michelle Odneal | Behavior Technician | 16915 Liverpool Pkwy. Suite B., Cornelius, NC 28301 | 2020-10-02 |
| 1790390094 | Jessica Shellman | Counselor | 408 Person St. Ste 103, Fayetteville, NC 28301 | 2020-09-14 |
| 1487205951 | Martha K Richardson | Technician | 720 Teachers Dr, Fayetteville, NC 28301 | 2019-09-25 |
| 1013568161 | Angela Rena Locklear | Counselor | 211 Lamon St, Fayeteville, NC 28301 | 2019-09-20 |
| 1619535747 | Teresa Wilson | Contractor | 1417 Canyionland Ct, Apt 209, Fayetteville, NC 28301 | 2019-06-04 |
| 1912461815 | Catherine Stevenson Nwogalanya | Community Health Worker | 1103 Hillsboro St., Fayetteville, NC 28301 | 2019-01-24 |
| 1811443187 | Michael Carroll | Counselor | 308 Peterson Place, Fayetteville, NC 28301 | 2016-08-28 |
| 1023499886 | Latifa Fedai | Nurse Practitioner | 380 Person Street, Fayettevill, NC 28301 | 2015-06-17 |
| 1265868939 | Aci Support Specialists | Community/Behavioral Health | 1725 Venna Drive, Fayetteville, NC 28301 | 2013-09-25 |
| 1871929547 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 2820 Copenhagen Drive, Fayetteville, NC 28301 | 2013-09-25 |
| Find all providers in zip 28301 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| 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’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619576352 | Bianca Faith Monroe | Counselor | 111 Lamon St Ste 100, Fayetteville, NC 28301-4917 | 2020-10-23 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1760032239 | Peyton Elaine Smith | Counselor | 2403 Main Dr Ste 1&2, Fayetteville, AR 72704-5223 | 2019-09-17 |
| 1467014746 | Tennille Kristine Wilson | Counselor | 6415 Camden Rd Ste 109, Fayetteville, NC 28306-7584 | 2019-07-08 |
| 1366914004 | Katie Frankum | Counselor | 6805 Woodmark Dr, Fayetteville, NC 28314-6458 | 2018-12-19 |
| 1588132534 | Sara Penney | Counselor | 351 Wagoner Dr Ste 135, Fayetteville, NC 28303-4608 | 2018-11-07 |
| 1578045589 | Tamara Smith Thom | Counselor | 2307 Cumberland Gap Dr, Fayetteville, NC 28306-6940 | 2018-09-06 |
| 1003393968 | Melissa Stone Martinez | Counselor | 175 Bradford Sq Ste D, Fayetteville, GA 30215-1967 | 2018-07-24 |
| 1629561568 | Hamlin Glover Consulting Group, LLC | Counselor | 3681 Raeburn Ct, Fayetteville, NC 28314-2623 | 2018-06-13 |
| 1861983439 | Jessica Lynne Smith | Counselor | 6885 Cliffdale Rd Ste 2002, Fayetteville, NC 28314 | 2018-05-19 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28301 |
Please comment or provide details below to improve the information on MR. KELVIN D CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.