Active NPI
Carla Clark
- Clinical Social Worker
- Columbus, OH
National Provider Identifier
1114385606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.900145
- Practice address
- 2440 Dawnlight Ave
Columbus, OH 43211-1934 - Phone
- (614) 481-5050
- NPI assigned
- Jan 29, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ICDC.111008-CS | OH | |
| Clinical Social Worker | 1041C0700X | I.900145 | OH | Primary |
Addresses
Primary practice location
2440 Dawnlight Ave
Columbus, OH 43211-1934
Mailing address
2440 Dawnlight Ave
Columbus, OH 43211-1934
Phone (614) 481-5050
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ICDC.111008-CS | OH | MD | Addiction (Substance Use Disorder) Counselor |
| I.900145 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454025600000",
"number": "1114385606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2440 DAWNLIGHT AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432111934",
"telephone_number": "614-481-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2440 DAWNLIGHT AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432111934",
"telephone_number": "614-481-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CARLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-29",
"last_updated": "2016-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "ICDC.111008-CS",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.900145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.