Provider Demographics
NPI:1679504997
Name:CLARK, VALERIE JORDAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:JORDAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361A VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1897
Mailing Address - Country:US
Mailing Address - Phone:757-456-2366
Mailing Address - Fax:757-456-2367
Practice Address - Street 1:4855 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4446
Practice Address - Country:US
Practice Address - Phone:757-467-7707
Practice Address - Fax:757-495-3206
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO802295MOtherSENTARA-OPTIMA-OFC
VA010264359OtherVIRGINIA PREMIER HEALTH
VA197565OtherANTHEM BLUE CROSS BLUE SH
VA010264359Medicaid