Healthcare Provider Details

I. General information

NPI: 1710897954
Provider Name (Legal Business Name): DEVIN CLARK LCMHC-A, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COPPERFIELD BLVD NE
CONCORD NC
28025-2428
US

IV. Provider business mailing address

300 COPPERFIELD BLVD NE
CONCORD NC
28025-2428
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-3131
  • Fax:
Mailing address:
  • Phone: 704-782-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: