Provider Demographics
NPI:1104845379
Name:CORWIN, CLARK C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:C
Last Name:CORWIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723-0123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4208 SIX FORKS RD
Practice Address - Street 2:BLDG 1, SUITE 305 A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5735
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7512
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0033381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003459Medicaid
NC135P9OtherBCBS NC
NC135P9OtherBCBS NC