Faith Clark, MSW, LICSW, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18726 Issued in MN

Practice address

227 7TH St
Two Harbors, MN 55616-1530

Phone

(218) 830-8085

NPI assigned

Feb 26, 2019

Last updated

Jan 31, 2022By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Agate Bay Professionals Chemical Health Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Two Harbors, MN
  • NPI 1568809366
  NPD Authorized official
• Kalina Counseling Services, LLC.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Two Harbors, MN
  • NPI 1245840735
  NPD (past)

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

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1194282160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 7TH ST",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161530",
            "telephone_number": "218-830-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 7TH ST",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161530",
            "telephone_number": "218-830-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "FAITH",
        "credential": "MSW, LICSW, LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-26",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303205",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "18726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Bushmaker
• Sara Byrns, M.A. CCC-SLP
• Daniel Cahill
• Cardinal Comfort Care Cooperative
• Amber L Christensen
• Melissa I Clark, MSW, LICSW
• Lee Jeffrey Cohen, MD
• Olivia Cooper, PT, DPT
• Bryan W Cox, DPT
• Cathleen Ann Cox, RN

• Clinical Social Worker in Two Harbors, MN
• Providers in Two Harbors, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.