MR. JOHN E CLARK III (NPI# 1699824763) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699824763 |
| Entity Type | Individual |
| Full Name | MR. JOHN E CLARK III |
| Practice Address |
10390 Democracy Ln Fairfax VA 22030-2522 |
| Mailing Address |
11561 Shadbush Ct Reston VA 20191-3009 |
| Practice Telephone | 7032192578 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
0710101131 | VA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245890672 | John Douglas Clark Jr. | Family Medicine | 54 Meadowbrook Cir, Brevard, NC 28712-8543 | 2019-06-18 |
| 1063072973 | John Riley Clark | Physician Assistant | 2700 Light Rd Apt 102, Oswego, IL 60543-9231 | 2019-06-13 |
| 1871909986 | John Clark | Internal Medicine | 740 Bethlehem Pike, Flourtown, PA 19031-1318 | 2014-07-09 |
| 1831444017 | John Arnot Clark | Dermatology | 1849 Mission Ridge Road, Santa Barbara, CA 93103-1857 | 2012-07-13 |
| 1427327428 | John Jacob Clark | Pharmacist | 1312 Northland Drive, Mendota Heights, MN 55120 | 2011-12-20 |
| 1841580586 | John Alan Clark | Pharmacist | 1900 Argillite Rd, Flatwoods, KY 41139-1616 | 2011-04-14 |
| 1740586932 | John Casey Clark | Occupational Therapist | 448 Lewis Hargett Cir, Suite 100, Lexington, KY 40503-3594 | 2011-02-04 |
| 1023327921 | John M Clark | Social Worker | 3528 Manchester Rd, Wantagh, NY 11793-3010 | 2010-09-27 |
| 1831417922 | John Russell Clark | Speech-Language Pathologist | 7811 Cobden Rd, Laverock, PA 19038-7257 | 2010-05-13 |
| 1518151513 | John M Clark | Physical Therapist | 1202 Se 6th St, Wagoner, OK 74467-6316 | 2007-09-02 |
| Street Address |
10390 DEMOCRACY LN |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932121290 | Gail W Campbell | Counselor | 10390 Democracy Ln, Fairfax, VA 22030-2522 | 2006-07-24 |
| 1689091183 | Jennifer Hansbrough | Case Manager/Care Coordinator | 10390 Democracy Ln, Fairfax, VA 22030-2522 | 2014-03-21 |
| 1275683765 | Jeannie Haston | Social Worker | 10390 Democracy Ln, Fairfax, VA 22030-2522 | 2007-01-10 |
| 1588687263 | Anil R Hinnaria | Psychiatry & Neurology | 10390 Democracy Ln, Fairfax Ads Outpatient, Fairfax, VA 22030-2522 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469974 | Lifeline Psychotherapy Services | Counselor | 11350 Random Hills Rd Ste 800, Fairfax, VA 22030-6044 | 2017-10-24 |
| 1770959603 | Kimberley L Berlin | Counselor | 10640 Page Ave, Fairfax, VA 22030-4000 | 2015-08-14 |
| 1669852026 | Transitions...the Process of Change | Counselor | 8280 Willow Oaks Corporate Dr, Suite 600, Fairfax, VA 22031-4518 | 2015-06-01 |
| 1861724445 | Carolyn Elizabeth Kuchel | Counselor | 4505 Shirley Gate Rd, Fairfax, VA 22030-5522 | 2010-02-05 |
| 1982938361 | William Alberti Prasad | Counselor | 4100 Chain Bridge Rd, 6-121, Fairfax, VA 22030-7003 | 2009-10-01 |
| 1679736342 | Maria Christine Hadjiyane | Counselor | 3615 Chain Bridge Rd Unit I, Integrative Psychotherapy Institute, Fairfax, VA 22030 | 2008-07-03 |
| 1437223922 | Life Line Addictions Foundation Inc. | Counselor | 10374 Democracy Ln Ste A, Fairfax, VA 22030-2557 | 2006-11-17 |
| 1932121290 | Gail W Campbell | Counselor | 10390 Democracy Ln, Fairfax, VA 22030-2522 | 2006-07-24 |
| 1609898154 | David Alan Jacobs | Counselor | 3900 Jermantown Rd Ste 200, Fairfax, VA 22030-4900 | 2006-07-24 |
| 1053339929 | Roberta E Severo | Counselor | 3912 Pineland St, Fairfax, VA 22031-3321 | 2006-07-18 |
| Find all providers in FAIRFAX | ||||
Please comment or provide details below to improve the information on MR. JOHN E CLARK III.
| 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.