Justin Clark, BA HISTORY

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

1280 Central Dr
Southern Pines, NC 28387-2102

Phone

(910) 692-3323

Fax

(910) 692-1114

NPI assigned

Apr 11, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

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.

• Sandhills Children'S Center

  • Developmental Therapist
  • Southern Pines, NC
  • NPI 1649604372
  NPD (past)
• Sandhills Childrens Center

  • Developmental Disabilities Clinic/Center
  • Southern Pines, NC
  • NPI 1013082312
  NPD (past)

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365638400000",
    "number": "1114360807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 CENTRAL DR",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283872102",
            "telephone_number": "910-692-3323",
            "fax_number": "910-692-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 CENTRAL DR",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283872102",
            "telephone_number": "910-692-3323",
            "fax_number": "910-692-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUSTIN",
        "credential": "BA HISTORY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-11",
        "last_updated": "2013-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300012",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren B. Chriscoe, AGPCNP-BC
• Pamela S Christaldi, NP
• Kimberly A Christensen, LCSW
• Thomas Christensen
• Christina L. Powers, DDS, PLLC
• Kevin Lee Clark Jr., LCAS-A
• Timothy Hall Clark, RPH
• Kathleen M. Clarke-Pearson, M.D.
• Classic Care Cap Services
• CNC / Access, Inc.

• Developmental Therapist in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Developmental Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.