KEVIN CLARK (NPI# 1245851104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245851104 |
| Entity Type | Individual |
| Full Name | KEVIN CLARK |
| Practice Address |
3929 Old Lee Hwy Ste 92c Fairfax VA 22030-2421 |
| Mailing Address |
8224 Frog Hollow Ct Manassas VA 20111-5259 |
| Practice Telephone | 7034774830 |
| Mailing Telephone | 7034774830 |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-05-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
0710103244 | VA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598294001 | Kevin John Clark | Chiropractor | 2815 83rd St, Darien, IL 60561-1660 | 2017-06-08 |
| 1124402516 | Kevin Michael Clark | Dentist | 8 Inwood Peak, San Antonio, TX 78248-1654 | 2015-07-15 |
| 1275976276 | Kevin P Clark | Pharmacist | 215 Sixth Street, Hotchkiss, CO 81419-0928 | 2013-04-10 |
| 1265736508 | Kevin Clark | Acupuncturist | 415 Route 34, Suite 210, Colts Neck, NJ 07722-2522 | 2010-12-30 |
| 1033361381 | Kevin Dewitt Clark | Acupuncturist | 130 N Dixie Hwy, Hollywood, FL 33020-6704 | 2008-10-17 |
| 1891859278 | Kevin Landis Clark | Optometrist | 10415 Gateway Blvd W, El Paso, TX 79925-7905 | 2006-12-20 |
| 1609934397 | Kevin John Clark | Counselor | 251 E 5th St, Brooklyn, NY 11218-2403 | 2006-12-05 |
| 1912947144 | Kevin Grafton Clark | Optometrist | 5310 Highway 25, Suite 5, Flowood, MS 39232-6148 | 2006-06-07 |
| 1235127291 | Kevin N Clark | Surgery | 425 Medical Dr, Ste 101, Bountiful, UT 84010-4945 | 2005-10-12 |
| 1497376958 | Kevin P. Clark Sr. | Social Worker | 30 Harriman Dr, Goshen, NY 10924-2410 | 2020-05-06 |
| Street Address |
3929 OLD LEE HWY STE 92C |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336709930 | Valerie Gayle Hadeed | Counselor | 3929 Old Lee Hwy Ste 92c, Fairfax, VA 22030-2421 | 2019-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469974 | Lifeline Psychotherapy Services | Counselor | 11350 Random Hills Rd Ste 800, Fairfax, VA 22030-6044 | 2017-10-24 |
| 1770959603 | Kimberley L Berlin | Counselor | 10640 Page Ave, Fairfax, VA 22030-4000 | 2015-08-14 |
| 1669852026 | Transitions...the Process of Change | Counselor | 8280 Willow Oaks Corporate Dr, Suite 600, Fairfax, VA 22031-4518 | 2015-06-01 |
| 1861724445 | Carolyn Elizabeth Kuchel | Counselor | 4505 Shirley Gate Rd, Fairfax, VA 22030-5522 | 2010-02-05 |
| 1982938361 | William Alberti Prasad | Counselor | 4100 Chain Bridge Rd, 6-121, Fairfax, VA 22030-7003 | 2009-10-01 |
| 1679736342 | Maria Christine Hadjiyane | Counselor | 3615 Chain Bridge Rd Unit I, Integrative Psychotherapy Institute, Fairfax, VA 22030 | 2008-07-03 |
| 1437223922 | Life Line Addictions Foundation Inc. | Counselor | 10374 Democracy Ln Ste A, Fairfax, VA 22030-2557 | 2006-11-17 |
| 1932121290 | Gail W Campbell | Counselor | 10390 Democracy Ln, Fairfax, VA 22030-2522 | 2006-07-24 |
| 1609898154 | David Alan Jacobs | Counselor | 3900 Jermantown Rd Ste 200, Fairfax, VA 22030-4900 | 2006-07-24 |
| 1053339929 | Roberta E Severo | Counselor | 3912 Pineland St, Fairfax, VA 22031-3321 | 2006-07-18 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.