Dominique Monche' Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C10935 Issued in MS

Practice address

6551 Anna May Dr
Walls, MS 38680-9214

Phone

(901) 359-1283

NPI assigned

Apr 3, 2024

Last updated

May 19, 2025By the provider in NPPES

Sex

Female

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

Enrolled in AR, MS2 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

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uppal Medical Center LLCGroup PAC ID 4587998547, 129 clinicians

MDB Behavioral Health Services LLCGroup PAC ID 0749572915, 201 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dominique.clark.2@30992.direct.athenahealth.com

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.

• MDB Behavioral Health Services LLC

  dba Complete Care Rural Health Clinic

  • Rural Health Clinic/Center
  • Vicksburg, MS
  • NPI 1669835310
  Medicare reassignment Care Compare group NPD
• Uppal Medical Center LLC

  • Rural Health Clinic/Center
  • Greenville, MS
  • NPI 1558927905
  Medicare reassignment Care Compare group NPD
• MDB Care Management LLC

  • Primary Care Nurse Practitioner
  • Flowood, MS
  • NPI 1144925272
  Medicare reassignment NPD
• Minor Med Care, LLC

  • Primary Care Clinic/Center
  • Jackson, MS
  • NPI 1407968738
  Medicare reassignment NPD
• Supportive Psych Care of Arkansas PA

  • Psychiatry Physician
  • Siloam Springs, AR
  • NPI 1437887437

  Clinical

  Medicare reassignment NPD
• Minor Med Care, LLC

  • Rural Health Clinic/Center
  • Raymond, MS
  • NPI 1669575627
  NPD
• West Alabama AIDS Outreach Inc

  dba Five Horizons Health Services

  • Infectious Disease Physician
  • Tuscaloosa, AL
  • NPI 1942043070
  NPD

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1871345892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6551 ANNA MAY DR",
            "city": "WALLS",
            "state": "MS",
            "postal_code": "386809214",
            "telephone_number": "901-359-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6551 ANNA MAY DR",
            "city": "WALLS",
            "state": "MS",
            "postal_code": "386809214",
            "telephone_number": "901-359-1283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DOMINIQUE",
        "middle_name": "MONCHE'",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-03",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C10935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrese Adams, PCAT
• Melinda Bell, MAHSC
• Carter's Healthcare Consulting Group (Carter's Healthcare & Lifestyle Medicine Group)
• City of Horn Lake (City of Horn Lake Ambulance Service)
• Diann Clark, MS, CAT
• Marcus Clark
• Compassionate Hearts Home Care Services, LLC
• Jessica Davis, LCSW
• Desoto County Office of Board of Supervisors (DeSoto County EMS)
• Desoto County Schools

• Clinical Social Worker in Walls, MS
• Providers in Walls, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; 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.