Katelyn E Clark, LPC
Individual provider Active NPI Professional Counselor · Bristow, VA
NPI 1194485912 · NPPES record last updated Dec 20, 2021
Key facts
- NPI
- 1194485912
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701011080 (VA)
- Practice address
- 11835 Hazel Circle Dr
Bristow, VA 20136-1223 - Phone
- (571) 416-0537
- NPI assigned
- Dec 20, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 0701011080 | VA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth for Tomorrow New Life Center, Inc. | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701011080 | VA | Yes |
Addresses
Primary practice location
11835 Hazel Circle Dr
Bristow, VA 20136-1223
Mailing address
11835 Hazel Circle Dr
Bristow, VA 20136-2180
Phone (571) 416-0537
Other providers in Bristow, VA
- Charco Agency
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- Choi'S Acupuncture & Herb Clinic
- Teresa Christopher
- Patricia Cisnero
- Patricia Clubb
- Paul T Colbourne
- Kylie Rachelle Coley
- Chaz Taylor Collins
- Carlos Joel Contreras
All providers in Bristow, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2021. 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.