Provider Demographics
NPI:1568743318
Name:CLARK, RACHEL (MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-9453
Mailing Address - Country:US
Mailing Address - Phone:919-323-6051
Mailing Address - Fax:919-813-2025
Practice Address - Street 1:21 HILLSBORO ST STE 7
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5936
Practice Address - Country:US
Practice Address - Phone:919-636-9757
Practice Address - Fax:919-813-2025
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1502101YA0400X
NCC0074081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)