Abraham Lewis Clark

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RIC1401231658 Issued in CA

Practice address

1901 Cleveland Avenue, #B
Santa Rosa Treatment Program
Santa Rosa, CA 95401

Phone

(707) 576-0818

NPI assigned

Feb 3, 2014

Sex

Male

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

State licenses

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

{
    "created_epoch": "1391385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1720401367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CLEVELAND AVENUE, #B",
            "address_2": "SANTA ROSA TREATMENT PROGRAM",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95401",
            "telephone_number": "707-576-0818",
            "fax_number": "707-576-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 CLEVELAND AVENUE, #B",
            "address_2": "SANTA ROSA TREATMENT PROGRAM",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95401",
            "telephone_number": "707-576-0818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ABRAHAM",
        "middle_name": "LEWIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-03",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RIC1401231658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharman Louise Cippa, LCSW
• Patricia Ann Cisco, MFT
• Sabrina M. Cito, RN
• Courtney Ann Clamp, MD
• Elizabeth Claret
• Andrea Clark
• Clelia Alexandra Clark, MD
• Jennifer Lee Clark
• Jennifer M. Clark, R.N., FNP, PMHNP
• Johnson Jack Clark Jr., MD

• Addiction (Substance Use Disorder) Counselor in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.