Healthcare Provider Details

I. General information

NPI: 1699631663
Provider Name (Legal Business Name): ERIC E CLARK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 STONEY CREEK DR
VALDESE NC
28690-9434
US

IV. Provider business mailing address

3139 STONEY CREEK DR
VALDESE NC
28690-9434
US

V. Phone/Fax

Practice location:
  • Phone: 828-302-6076
  • Fax:
Mailing address:
  • Phone: 828-302-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: