Michael Clark, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P017249 Issued in NC

Practice address

3126 Milton Rd Ste 232
Charlotte, NC 28215-3782

Phone

(704) 930-0680

Fax

(855) 655-2688

NPI assigned

Mar 5, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Networks

• devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

• Direct secure messaging: mclark722908@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina'S Creative Counseling, PA

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1114156163
  NPD (past)
• Choose Better 4 U, PLLC

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1336625060
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646438400000",
    "number": "1023765435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8640 UNIVERSITY CITY BLVD STE A3153",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282133501",
            "telephone_number": "980-202-2526",
            "fax_number": "855-655-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3126 MILTON RD STE 232",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282153782",
            "telephone_number": "704-930-0680",
            "fax_number": "855-655-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-05",
        "last_updated": "2022-03-05",
        "certification_date": "2022-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Clark, LCMHC, LCASA, LPC
• Lisa R Clark, PT
• Luke Samuel Clark, PA-C
• Lyndsay Clark, PA
• Megan Montgomery Clark, MACC, LPCA
• Natalie Clark, LCAS-A
• Olivia Clark
• Peter Earl Clark, MD
• Robert Brandon Clark, FNP
• Ronald Sevier Clark, CRNA

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.