Clark & Clark Counseling Center, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC005485 Issued in GA

Legal business name

CLARK & CLARK COUNSELING CENTER, LLC

Practice address

10 Wilson Rd
Suite 9
Stockbridge, GA 30281-4468

Phone

(678) 438-4225

Fax

(678) 272-6295

NPI assigned

Sep 10, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Susan M Clark, LPC

Title

Doctor/Owner

Phone

(678) 438-4225

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1972853638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WILSON RD",
            "address_2": "SUITE 9",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814468",
            "telephone_number": "678-438-4225",
            "fax_number": "678-272-6295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WILSON RD",
            "address_2": "SUITE 9",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814468",
            "telephone_number": "678-438-4225",
            "fax_number": "678-272-6295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK & CLARK COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "678-438-4225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC005485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143387363A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Chukwuma, PT, DPT
• Circle of Therapeutic Alliance and Consulting, LLC
• City EMS
• CJ Pediatrics LLC
• Dorian Claggett
• Jeanine Clark, FNP
• Stephanie Nicole Clark
• Susan Marie Clark, PH.D
• Shanique Clarke
• Rashonda L Clay-Douthit, LCSW

• Community/Behavioral Health Agency in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; 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.