Healthcare Provider Details

I. General information

NPI: 1780702225
Provider Name (Legal Business Name): STEPHEN DONALD CLARK LPC LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 US HIGHWAY 17 N
WILMINGTON NC
28411-6878
US

IV. Provider business mailing address

PO BOX 277
HAMPSTEAD NC
28443-0277
US

V. Phone/Fax

Practice location:
  • Phone: 910-317-5054
  • Fax: 910-681-3718
Mailing address:
  • Phone: 910-617-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number466
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2348
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: