Connie Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

620 Wellhouse Dr
Jacksonville, FL 32220-1367

Phone

(904) 222-1784

Fax

(904) 253-3001

NPI assigned

Dec 30, 2013

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1388361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388361600000",
    "number": "1528489002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 WELLHOUSE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322201367",
            "telephone_number": "904-222-1784",
            "fax_number": "904-253-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 WELLHOUSE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322201367",
            "telephone_number": "904-222-1784",
            "fax_number": "904-253-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CONNIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-30",
        "last_updated": "2013-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlee Hutcheson Clark, APRN
• Barrie Raye Clark, DO
• Bennie Clark Jr., DMD
• Caitlin Drew Clark, SLP-CCC
• Charles S Clark
• De'Atra Pruett Clark, OT
• Demetria Angelica Clark, PA
• Destiny Sade Clark
• Elexus Kristina Clark
• James Douglas Clark, LCSW

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; 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.