MEDICARE: KEVIN CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1023941366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CLARK

Provider Business Mailing Address
First Line	:	3 TIDWAY CIR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-3128
Country	:	US
Telephone Number	:	843-507-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2049 SAVANNAH HWY STE D
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-2228
Country	:	US
Telephone Number	:	843-507-2299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

Similar Medicare Providers

1811821226 — SONYA HANSON
Practice Location Address:

2049 SAVANNAH HWY STE D
CHARLESTON, SC
29407-2228

Practice Phone: 800-244-4691
Practice Fax:

1497771919 — EXPRESS MEDICAL CARE
Practice Location Address:

2049 SAVANNAH HWY , SUITE D
CHARLESTON, SC
29407-2228

Practice Phone: 843-852-0551
Practice Fax: 843-852-0552

1255427142 — SHARIFIAN CHARLESTON DENTAL GROUP, PC, A NEVADA PROFESSIONAL CORP
Practice Location Address:

2001 W CHARLESTON BLVD
LAS VEGAS, NV
89102-2228

Practice Phone: 702-366-1407
Practice Fax: 702-853-0533

1427736404 — TRUSTED RESULTS THERAPY GROUP LLC
Practice Location Address:

2000 SAM RITTENBURG BLVD , SUITE 2011
CHARLESTON, SC
29407-4631

Practice Phone: 843-793-2104
Practice Fax: 843-654-4850

1053267104 — DUANE NALDO FROES AGACNP
Practice Location Address:

1033 SAINT ANDREWS BLVD
CHARLESTON, SC
29407-7156

Practice Phone: 843-723-6111
Practice Fax: 843-727-2973

1942629415 — COURTNEY GUINYARD
Practice Location Address:

1 CARRIAGE LN
CHARLESTON, SC
29407-6060

Practice Phone: 843-604-4577
Practice Fax:

Directions to “ KEVIN CLARK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.