Skylor Maxx Clark, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P016832 Issued in NC

Practice address

1117 Kauri Cliffs Dr
Fuquay Varina, NC 27526-3830

Phone

(336) 504-4090

NPI assigned

Jan 11, 2023

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1699489922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 KAURI CLIFFS DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275263830",
            "telephone_number": "336-504-4090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 KAURI CLIFFS DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275263830",
            "telephone_number": "336-504-4090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SKYLOR",
        "middle_name": "MAXX",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P016832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darren A Ciccolini, PA-C
• Breah Claar, CCC-SLP
• Jacob Joel Clairmont, PA
• Clark Christian Counseling, PLLC
• Lance Clark, MA, LCMHC, BCTMH, QS
• Rebecca Clarke, M.S., CCC-SLP
• Clearly Kommon LLC
• Michele Elane Clephane, L.M.B.T.
• Cameron Waters Clinard, OD
• Valerie B Clinard, PHARMD

• Clinical Social Worker in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.