Healthcare Provider Details

I. General information

NPI: 1114777653
Provider Name (Legal Business Name): JOSEPH CLARK LCADC, CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 BARDSTOWN RD # 2677
LOUISVILLE KY
40291-3050
US

IV. Provider business mailing address

6844 BARDSTOWN RD # 2677
LOUISVILLE KY
40291-3050
US

V. Phone/Fax

Practice location:
  • Phone: 502-762-8488
  • Fax:
Mailing address:
  • Phone: 502-762-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number359270
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number300380
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: