NPIMap

Organization Active NPI

A Clark Minority Company LLC

  • Mental Health Counselor
  • Ponte Vedra Beach, FL
National Provider Identifier
1306385448
Registry record updated Feb 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
A CLARK MINORITY COMPANY LLC
Practice address
4615 Marsh Hawk PL
Ponte Vedra Beach, FL 32082-3027
Phone
(904) 463-1693
NPI assigned
Feb 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2017

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

Authorized official

Name
Mr. James Douglas Clark, LCSW,ACSW,CFRE
Title
President/Eo
Phone
(904) 463-1693

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4615 Marsh Hawk PL
Ponte Vedra Beach, FL 32082-3027

Mailing address

4615 Marsh Hawk PL
Ponte Vedra Beach, FL 32082-3027
Phone (904) 463-1693

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1306385448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4615 MARSH HAWK PL",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823027",
            "telephone_number": "904-463-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4615 MARSH HAWK PL",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823027",
            "telephone_number": "904-463-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A CLARK MINORITY COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT/EO",
        "authorized_official_telephone_number": "904-463-1693",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW,ACSW,CFRE"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; 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.