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NPI Code Detail

MEDICARE: MR. EVAN HALE CLARK MSW

MEDICARE: MR. EVAN HALE CLARK MSW
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
1104100000XSocial WorkerBP02943902WV

General Provider Information

NPI Number : 1619825320
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVAN HALE CLARK MSW
Provider Business Mailing Address
First Line : 529 BATTLE AVE
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-5626
Country : US
Telephone Number : 540-303-2917
Fax Number :
Provider Business Practice Location Address
First Line : 400 FOXCROFT AVE STE 101
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-5302
Country : US
Telephone Number : 304-443-1408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “ MR. EVAN HALE CLARK MSW” Practice Location

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