MEDICARE: STEPHEN DONALD CLARK LPC LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2348	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	466	NC

General Provider Information

NPI Number	:	1780702225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN DONALD CLARK LPC LCAS

Provider Business Mailing Address
First Line	:	PO BOX 277
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-0277
Country	:	US
Telephone Number	:	910-617-5054
Fax Number	:

Provider Business Practice Location Address
First Line	:	10390 US HIGHWAY 17 N
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-6878
Country	:	US
Telephone Number	:	910-317-5054
Fax Number	:	910-681-3718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/11/2025

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