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General NPI Number Information
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NPI Number | 1265736508
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Entity Type | Individual
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Provider Name | KEVIN CLARK DAOM, LAC, NCC, EMDR
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Gender | Male
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 543 OLD YORK RD
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City | ALLENTOWN
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State | NJ
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Zip | 08501-1808
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Country | US
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Telephone | 302-249-0143
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Fax |
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Provider Business Mailing Address
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Address Line | 543 OLD YORK RD
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City | ALLENTOWN
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State | NJ
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Zip | 08501-1808
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Country | US
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Telephone | 302-249-0143
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2025-000205
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00104200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | CQ-0000029
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37AC00916700
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License Number State | NJ
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