Active NPI
Kelvin D Clark, MS, LMFT, LPC, LCAS
- Addiction (Substance Use Disorder) Counselor
- Fayetteville, NC
National Provider Identifier
1033165923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 1500 Bragg Blvd
Fayetteville, NC 28301-4289 - Phone
- (910) 323-1065
- Fax
- (910) 323-1144
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 448 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | NC | Primary | |
| Marriage & Family Therapist | 106H00000X | 448 | NC |
Addresses
Primary practice location
1500 Bragg Blvd
Fayetteville, NC 28301-4289
Mailing address
3805 Woodside Dr
Sanford, NC 27332-8110
Phone (919) 776-0399
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14762257 | Other | NC | UNITED HEALTHCARE |
| 1002X | Other | NC | BLUE CROSS PROVIDER |
| 6102267 | Medicaid | NC | |
| 11367606 | Other | NC | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 448 | NC | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1033165923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3805 WOODSIDE DR",
"city": "SANFORD",
"state": "NC",
"postal_code": "273328110",
"telephone_number": "919-776-0399",
"fax_number": "910-323-1144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 BRAGG BLVD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283014289",
"telephone_number": "910-323-1065",
"fax_number": "910-323-1144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KELVIN",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "MS, LMFT, LPC, LCAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "448",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": null,
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "448",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "14762257",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER",
"identifier": "1002X",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102267",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11367606",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.