Shanavier Clark
Individual provider Active NPI Social Worker · Gulfport, MS
NPI 1477044071 · NPPES record last updated Nov 24, 2025
Key facts
- NPI
- 1477044071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- C11808 (MS)
- Practice address
- 15024 Martin Luther King Jr Blvd
Gulfport, MS 39501-8306 - Phone
- (228) 864-0003
- Fax
- (228) 863-7917
- NPI assigned
- May 21, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Coastal Family Health Center, Inc
Practice addresses (Care Compare)
15024 Martin Luther King Jr Blvd
Gulfport, MS 39501-8306
Phone (228) 864-0003
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260114004034 | MS | Practitioner - Clinical Social Worker | 6002392503 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C11808 | MS | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Family Health Center, Inc | Current |
Accepting new patients | |
| Coastal Family Health Center, Inc. | Current |
Accepting new patients | |
| Metro Treatment of Mississippi LP | Past | Accepting new patients |
Locations
715A Division St
Biloxi, MS 39530
Phone (228) 374-4991
1046 Division St
Biloxi, MS 39530
Phone (225) 374-2494
15024 Mlk
Gulfport, MS 39501
Phone (228) 846-0003
10467 Corporate Dr
Gulfport, MS 39503
Phone (228) 375-2494
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Social Worker | 104100000X | C11808 | MS | Yes |
Addresses
Primary practice location
15024 Martin Luther King Jr Blvd
Gulfport, MS 39501-8306
Mailing address
10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494
Other providers in Gulfport, MS
- John Saunders Clark
- Karmin Clark
- Lindberg Clark
- Sabrina Willis Clark
- Sarah Clark
- Claveau Counseling Center
- Louanna Claveau
- Esther Faye Clay-Arrant
- Ayana Clay
- Clear Families Chiropractic LLC
All providers in Gulfport, MS · Social Worker in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.