Jasmine Joanne Moore-Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012828 Issued in NC

Practice address

9711 David Taylor Drve
Ste 213
Charlotte, NC 28262-3310

Phone

(980) 875-7079

Fax

(980) 500-0158

NPI assigned

Jan 23, 2020

Last updated

Aug 7, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243

  Clinical

  NPD (past)

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1295365740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 EVA DR NW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280275501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9711 DAVID TAYLOR DRVE",
            "address_2": "STE 213",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282623310",
            "telephone_number": "980-875-7079",
            "fax_number": "980-500-0158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE-CLARK",
        "first_name": "JASMINE",
        "middle_name": "JOANNE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Jay Moone, L.P.A.
• Moonfire Wellness, Inc.
• Jajuana Demetrice Moonie
• Rachel E Moor, PA
• Moore Optometry, PLLC
• Chelandra Shawnte Moore-Quarles, LPC
• Alexis Dolor Moore, PHD
• Amanda Michelle Moore
• Amiya Moore
• Amy Vischetti Moore, PA-C

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.