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General NPI Number Information
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NPI Number | 1033165923
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Entity Type | Individual
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Provider Name | KELVIN D CLARK MS, LMFT, LPC, LCAS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1500 BRAGG BLVD
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4289
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Country | US
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Telephone | 910-323-1065
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Fax | 910-323-1144
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Provider Business Mailing Address
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Address Line | 3805 WOODSIDE DR
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City | SANFORD
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State | NC
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Zip | 27332-8110
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Country | US
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Telephone | 919-776-0399
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Fax | 910-323-1144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 448
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 448
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License Number State | NC
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