Vivian Audrey Clark, LCSW,LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C009292 Issued in NC

Practice address

1935 J N Pease PL Ste 101
Charlotte, NC 28262

Phone

(704) 907-8242

Fax

(704) 973-0694

NPI assigned

Feb 9, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Capitolhill Consortium for Counseling & Consultation, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Washington, DC
  • NPI 1992965552

  DC, Single Specialty

  Medicare reassignment Care Compare group NPD
• Choice Unlimited, LLC

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1790419869

  Clinical, NC

  Medicare reassignment NPD
• Continuum Care Services, Inc.

  • Community/Behavioral Health Agency
  • Rockingham, NC
  • NPI 1013105709

  NC, Single Specialty

  Medicare reassignment NPD
• Arise Destiny LLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1437541877

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Continuum Care Services, Inc.

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1194074286
  NPD

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Capitolhill Consortium for Counseling and Consultation, LLC 18 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1265673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1811229362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 J N PEASE PL STE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624541",
            "telephone_number": "704-907-8242",
            "fax_number": "704-973-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 J N PEASE PL STE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28262",
            "telephone_number": "704-907-8242",
            "fax_number": "704-973-0694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10211 Meridale Crossing Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282697367",
            "country_code": "US",
            "telephone_number": "704-907-8242",
            "fax_number": "704-973-0694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "VIVIAN",
        "middle_name": "AUDREY",
        "name_prefix": "Ms.",
        "credential": "LCSW,LISW-CP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-09",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "SW.11115CP",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "2850-A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C009292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Prevatte Clark, LCSW
• Sueanne Clark, NP
• Summer Clark, PHARMD
• Talaya Blakey Clark, MD
• Terri L Clark
• Jessica Pease Clarke-Pounder, MD
• Caylee C Clarke, MA, BCBA
• Charissa Grace Clarke
• Cynthia E Clarke, RPH
• Elizabeth Melissa Clarke, ARNP

• All providers in Charlotte, NC
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.