Vicki Lyne Clark, M.ED.

Primary specialty

CounselorTaxonomy code 101Y00000X

License

E 0002811 Issued in OH

Practice address

12557 Ravenwood Dr
Chardon, OH 44024-9009

Phone

(440) 285-3568

Fax

(440) 285-4552

NPI assigned

Nov 27, 2006

Last updated

Sep 11, 2025By 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

Credentials

Master of Education

State licenses

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.

• Ravenwood Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chardon, OH
  • NPI 1053345975
  Authorized official Same address or phone
• Ravenwood Mental Health Center

  • Addiction (Substance Use Disorder) Counselor
  • Chardon, OH
  • NPI 1912265794
  Authorized official Same address or phone
• Ravenwood Mental Health Center

  dba Ravenwood Health

  • General Practice Physician
  • Chardon, OH
  • NPI 1932666740
  Authorized official Same address or phone

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1184790859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7068 CONSTANTINE CT",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605124",
            "telephone_number": "440-942-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12557 RAVENWOOD DR",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440249009",
            "telephone_number": "440-285-3568",
            "fax_number": "440-285-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "VICKI",
        "middle_name": "LYNE",
        "credential": "M.ED.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "E 0002811",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E 0002811",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Riana Christensen, LISW
• Eryn Church
• Christina Marie Ciofani
• Courtney Clark
• Megan Elizabeth Clark, DPM
• Dawn Cochran
• Cristina Gabriela Cognati
• Stephanie Cohen, OTR/L
• Kelsey Evelyn Cohn, BPH
• Elise Victoria Colacicco

• Counselor in Chardon, OH
• Providers in Chardon, OH by specialty
• Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.