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General NPI Number Information
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NPI Number | 1366030843
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Entity Type | Individual
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Provider Name | MATTHEW SCOTT CLARK MS, LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 01/09/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 3029 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-2506
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Country | US
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Telephone | 202-948-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 800 P ST NW APT 708
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City | WASHINGTON
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State | DC
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Zip | 20001-3382
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Country | US
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Telephone | 717-379-2790
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC011603
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC15451
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License Number State | DC
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