Provider Demographics
NPI:1780702225
Name:CLARK, STEPHEN DONALD (LPC LCAS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DONALD
Last Name:CLARK
Suffix:
Gender:M
Credentials:LPC LCAS
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 277
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0277
Mailing Address - Country:US
Mailing Address - Phone:910-617-5054
Mailing Address - Fax:
Practice Address - Street 1:10390 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-6878
Practice Address - Country:US
Practice Address - Phone:910-317-5054
Practice Address - Fax:910-681-3718
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2348101YP2500X
NC466101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)