Carman Suzanne Clark, PSYCHOLOGIST, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC004465 Issued in GA

Practice address

149 Lee Byrd Rd Ste 11
Loganville, GA 30052-2310

Phone

(678) 215-7236

NPI assigned

Oct 17, 2007

Last updated

Aug 11, 2021By the provider in NPPES

Sex

Female

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

Locations

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

• Healing Heart Moments, Inc

  • Pastoral Counselor
  • Loganville, GA
  • NPI 1215578943

  Professional

  NPD Authorized official

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1073702924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 LEE BYRD RD STE 11",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310",
            "telephone_number": "678-215-7236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 LEE BYRD RD STE 11",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310",
            "telephone_number": "678-215-7236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARMAN",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "PSYCHOLOGIST, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-17",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lazina Choudhry, OD
• Christ the King Healthcare PC (Christ the King Medical Center)
• Circle of Care, Inc.
• Lydia Mikula Clackum, DPT
• Jordan T Cladd
• Charli Hicks Clements
• Laura Coffee, MA SLP
• Lola Colbert, DDS
• Gabrielle Kenitha Collins
• Ashley Lorraine Colvin

• Professional Counselor in Loganville, GA
• Providers in Loganville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.