Provider Demographics
NPI:1891364725
Name:CLARK, NAKIMA KINTE
Entity Type:Individual
Prefix:
First Name:NAKIMA
Middle Name:KINTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 GREEN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2848
Mailing Address - Country:US
Mailing Address - Phone:919-872-6220
Mailing Address - Fax:919-872-6223
Practice Address - Street 1:4805 GREEN RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2848
Practice Address - Country:US
Practice Address - Phone:919-872-6220
Practice Address - Fax:919-872-6223
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0163601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical