Sandra Denice Clark, ED.S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0804 Issued in MS

Practice address

5701 N Hills St
Meridian, MS 39307-2903

Phone

(601) 581-7562

Fax

(601) 581-7676

NPI assigned

Aug 30, 2010

Last updated

Aug 31, 2010By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Positive Innergy Counseling Services LLCGroup PAC ID 6204298367, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EJDBBA

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.

• Positive Innergy Counseling Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Meridian, MS
  • NPI 1003432626
  Medicare reassignment Care Compare group NPD
• Greater Meridian Health Clinic, Inc.

  dba Scooba Family Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Scooba, MS
  • NPI 1962509208
  Medicare reassignment NPD
• Greater Meridian Health Clinic, Inc

  dba GMHC Mobile Access Unit 2

  • Federally Qualified Health Center (FQHC)
  • Meridian, MS
  • NPI 1053046201
  NPD
• Greater Meridian Health Clinic, Inc.

  dba GMHC, INC./MPSD G W Carver Community School Base Clinic

  • Federally Qualified Health Center (FQHC)
  • Meridian, MS
  • NPI 1275046716
  NPD
• East Mississippi State Hospital

  dba Magnolia Medical Clinic

  • Multi-Specialty Clinic/Center
  • Meridian, MS
  • NPI 1346522653
  NPD (past)

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1205142106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4128",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393044128",
            "telephone_number": "601-581-7636",
            "fax_number": "601-581-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 N HILLS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393072903",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SANDRA",
        "middle_name": "DENICE",
        "name_prefix": "Mrs.",
        "credential": "ED.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-30",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MS",
            "license": "0804",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "LH0061",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "0804",
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "MS",
            "license": "168226",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grady Mims Clark Jr., O.D.
• James Eugene Clark, D.D.S.
• Kimberly Deyonne Clark, CMHT
• Robert E Clark, M.D.
• Ronald H Clark, DC
• Clarkdale Pharmacy and Gifts LLC (Clarkdale Pharmacy and Gifts)
• Demetrius Clay, LPC, ED.S, MS
• Olivia Grace Clay, ATC
• Comanechi Clayton, PMHNP-BC
• Danielle Clayton, PHARMD

• Professional Counselor in Meridian, MS
• Providers in Meridian, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.