Active NPI
Lisa Landers Clark, LPC
- Professional Counselor
- Savannah, GA
National Provider Identifier
1437485836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6672
- Practice address
- 1 Waterford LN
Savannah, GA 31411-1305 - Phone
- (602) 751-6077
- Fax
- (480) 452-1113
- NPI assigned
- Oct 20, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6672 | GA | Primary |
Addresses
Primary practice location
1 Waterford LN
Savannah, GA 31411-1305
Mailing address
1 Waterford LN
Savannah, GA 31411-1305
Phone (602) 751-6077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6672 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480377600000",
"number": "1437485836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 WATERFORD LN",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314111305",
"telephone_number": "602-751-6077",
"fax_number": "480-452-1113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WATERFORD LN",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314111305",
"telephone_number": "602-751-6077",
"fax_number": "480-452-1113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LISA",
"middle_name": "LANDERS",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-20",
"last_updated": "2016-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "6672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.