Faith Clark, MSW, LICSW, LADC
Individual provider Active NPI Clinical Social Worker · Two Harbors, MN
NPI 1194282160 · NPPES record last updated Jan 31, 2022
Key facts
- NPI
- 1194282160
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 18726 (MN)
- Practice address
- 227 7TH St
Two Harbors, MN 55616-1530 - Phone
- (218) 830-8085
- NPI assigned
- Feb 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 303205 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 18726 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agate Bay Professionals Chemical Health Services | Current | Accepting new patients | |
| Kalina Counseling Services, LLC. | Past |
Accepting new patients |
Locations
227 7th St
Two Harbors, MN 55616
Phone (218) 428-4956
120 7th St
Two Harbors, MN 55616
Phone (218) 595-7997
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 303205 | MN | |
| Clinical Social Worker | 1041C0700X | 18726 | MN | Yes |
Addresses
Primary practice location
227 7TH St
Two Harbors, MN 55616-1530
Mailing address
227 7TH St
Two Harbors, MN 55616-1530
Phone (218) 830-8085
Other providers in Two Harbors, MN
- Jennifer Bushmaker
- Sara Byrns
- Daniel Cahill
- Cardinal Comfort Care Cooperative
- Amber L Christensen
- Melissa I Clark
- Lee Jeffrey Cohen
- Olivia Cooper
- Bryan W Cox
- Cathleen Ann Cox
All providers in Two Harbors, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.