Kayla Clark, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC012786 Issued in GA

Practice address

106 E 5TH Ave
Rome, GA 30161-3128

Phone

(706) 509-0130

Fax

(706) 237-6503

NPI assigned

Aug 16, 2017

Last updated

Mar 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lavender Mountain Counseling

  • Mental Health Counselor
  • Rome, GA
  • NPI 1073386280
  NPD (past) Authorized official

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

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1730605320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 LEAFMORE RD SW APT B",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301653856",
            "telephone_number": "404-736-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E 5TH AVE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613128",
            "telephone_number": "706-509-0130",
            "fax_number": "706-237-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAYLA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-16",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "APC007128",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC012786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSURE",
            "identifier": "LPC012786",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole C. Christian, PH.D.
• Chulio Hills Health & Rehab, LLC
• Rosheika Monique Cineus
• City of Rome
• Candice Nicole Claiborne, PHD
• Linzee E Clark, DO
• Timothy Clark, PT
• Timothy Adam Clark, MD
• Jada Clarke, B.S.
• Richard Clay

• Mental Health Counselor in Rome, GA
• Providers in Rome, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.