Paul G Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904-001362 Issued in VA

Practice address

1 Gold Leaf Walk Way
Black Mountain, NC 28711-2804

Phone

(703) 740-0095

NPI assigned

Jan 10, 2012

Last updated

May 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Virginia Commonwealth University, School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1174893945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 UNIVERSITY DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304422",
            "telephone_number": "703-993-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOLD LEAF WALK WAY",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287112804",
            "telephone_number": "703-740-0095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PAUL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-10",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW0002836",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904-001362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda S Cearley, LPC, LCMHC, ATR-BC
• Elena Grace Cellitti, OTD, OTR/L
• Jonathan Erik Chaplinsky, LCSWA, LCASA
• Cheri Lisa Holmes
• Deirdre Schoen Christy, PH.D.
• Ryan Radwin Clark, PA-C
• Jessica Clarke
• Stephanie Clements, COTA
• Gena Cohen, LAC
• Cold Mountain Pharmacy Services (HealthRidge Pharmacy)

• Clinical Social Worker in Black Mountain, NC
• Providers in Black Mountain, 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 May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.