Angela Clark, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P1804053 Issued in AR

Practice address

1109 Burman Dr
Jacksonville, AR 72076-4386

Phone

(501) 982-7515

NPI assigned

Nov 24, 2015

Last updated

May 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Professional Counseling Associates Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville, AR
  • NPI 1053934703
  NPD (past)
• Professional Counseling Associates Inc.

  • Community/Behavioral Health Agency
  • North Little Rock, AR
  • NPI 1437164977
  NPD (past)

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

{
    "created_epoch": "1448323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525737600000",
    "number": "1184098469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 RICHARDS RD",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172954",
            "telephone_number": "501-221-1843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 BURMAN DR",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720764386",
            "telephone_number": "501-982-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANGELA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-24",
        "last_updated": "2018-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "A1510140",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1804053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CHG Cornerstone Hospital of Little Rock, LLC (Cornerstone Hospital of North Little Rock)
• Earnie D Childress Jr., QBHP
• Reginnia Marie Christian
• City of Jacksonville (City of Jacksonville EMS)
• Clararose Home Care
• Brianni Clark
• Kala Allene Clark, MHPP
• Meagan Nichole Clark, CNA
• Casey Marie Cline, COTA/L
• Clinical Specialty Infusions LLC (Csi Pharmacy)

• Professional Counselor in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; 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.