Active NPI
Hugh Clark Jr., LCSW
- Counseling Psychologist
- Camp Lejeune, NC
National Provider Identifier
1346770666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- C010704
- Practice address
- 100 Brewster Blvd
Camp Lejeune, NC 28547-2575 - Phone
- (910) 440-2080
- NPI assigned
- Jun 19, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | SW11255 | FL | |
| Counseling Psychologist | 103TC1900X | C010704 | NC | Primary |
Addresses
Primary practice location
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Mailing address
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Phone (910) 440-2080
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12510840 | Other | FL | CAQH |
| SW11255 | Other | FL | LCSW |
| C010704 | Other | NC | LCSW |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW11255 | FL | MD | Counseling Psychologist |
| C010704 | NC | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620604800000",
"number": "1346770666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472575",
"telephone_number": "910-440-2080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472575",
"telephone_number": "910-440-2080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "HUGH",
"name_suffix": "Jr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-19",
"last_updated": "2021-05-10",
"certification_date": "2021-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "FL",
"license": "SW11255",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NC",
"license": "C010704",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "12510840",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "SW11255",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "C010704",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camp Lejeune, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.