Paul G Clark, LCSW
Individual provider Active NPI Clinical Social Worker · Black Mountain, NC
NPI 1174893945 · NPPES record last updated May 18, 2023
Key facts
- NPI
- 1174893945
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904-001362 (VA)
- Practice address
- 1 Gold Leaf Walk Way
Black Mountain, NC 28711-2804 - Phone
- (703) 740-0095
- NPI assigned
- Jan 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- 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)
1 Gold Leaf Walk Way
Black Mountain, NC 28711-2804
Phone (703) 474-0095
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230802003758 | NC | Practitioner - Clinical Social Worker | 0446512214 | Practice locations: Black Mountain, NC |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW0002836 | FL | MD | Clinical Social Worker |
| 0904-001362 | VA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW0002836 | FL | |
| Clinical Social Worker | 1041C0700X | 0904-001362 | VA | Yes |
Addresses
Primary practice location
1 Gold Leaf Walk Way
Black Mountain, NC 28711-2804
Mailing address
4400 University Dr
Fairfax, VA 22030-4422
Phone (703) 993-2737
Other providers in Black Mountain, NC
- Miranda S Cearley
- Elena Grace Cellitti
- Jonathan Erik Chaplinsky
- Cheri Lisa Holmes
- Deirdre Schoen Christy
- Ryan Radwin Clark
- Jessica Clarke
- Stephanie Clements
- Gena Cohen
- Cold Mountain Pharmacy Services
All providers in Black Mountain, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.