Marvin Clark, CCHW

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

142899725 Issued in MI

Practice address

12841 E McNichols Rd
Detroit, MI 48205-3343

Phone

(313) 701-8314

NPI assigned

May 22, 2025

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

Practice roles

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.

• Life Is Love Thinking

  • Community Health Worker
  • Detroit, MI
  • NPI 1881585347
  NPD Authorized official

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

{
    "created_epoch": "1747872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1932992039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11366 WHITEHILL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482241653",
            "telephone_number": "313-701-8314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12841 E MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482053343",
            "telephone_number": "313-701-8314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARVIN",
        "credential": "CCHW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-22",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Community Health Worker",
            "state": "MI",
            "license": "142899725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Clark, CRNA
• Latasha Clark
• Latoya Clark
• Lincolin Henry Clark, FAODP
• Marcella Ruth Clark, MD
• Mary L Clark
• Maya Clark, NP
• Melba Lynette Clark
• Melissa Clark
• Michele Clark, LMSW

• Community Health Worker in Detroit, MI
• Providers in Detroit, MI by specialty
• Community Health Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.