Renee Clark

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

6440 Dobbin Rd
Columbia, MD 21045-4770

Phone

(410) 730-2385

NPI assigned

Feb 26, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1582675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1194359349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8167A EDGE ROCK WAY",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207246093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 DOBBIN RD",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454770",
            "telephone_number": "410-730-2385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-26",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "address_1": "6440 Dobbin Rd",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210454770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "address_1": "6440 Dobbin Rd",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210454770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather Darnell Clark, RN
• Jillian Clark, LCSW-C
• Marcus Clark
• Mary Kimberly Clark
• Melissa Aviva Clark, M.D.
• Shakya Marie Clark
• Cassandra Clarke-Williams, PH.D, LGPC
• Christina Elena Clarke, MD
• Jayyidah Clarke, LCSW-C
• Racquel Angella Clarke

• All providers in Columbia, MD
• Marriage & Family Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; 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.