Clark, Kelvin D

Clark, Kelvin D is an individual health care provider with primary practice located at 1500 Bragg Blvd , Fayetteville NC 28301-4289. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Counselor is his primary health care specialty. Clark, Kelvin D can be contacted via phone (910) 323-1065.

Contact Information

Primary practice address
1500 Bragg Blvd Fayetteville NC 28301-4289
Phone: (910) 323-1065
Fax: (910) 323-1144
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 448 North Carolina
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X North Carolina
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 448 North Carolina

Profile Details

NPI number 1033165923
LBN Legal business name Clark, Kelvin D
Credentials MS, LMFT, LPC, LCAS
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033165923 NPPES
North Carolina Other 14762257 UNITED HEALTHCARE
North Carolina Other 1002X UNITED HEALTHCARE
North Carolina MEDICAID 6102267 UNITED HEALTHCARE
North Carolina Other 11367606 UNITED HEALTHCARE

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