Individual
MR. KELVIN D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LMFT, LPC, LCAS
Contact information
Practice address
1500 BRAGG BLVD, FAYETTEVILLE, NC 28301-4289
(910) 323-1065
(910) 323-1144
Mailing address
3805 WOODSIDE DR, SANFORD, NC 27332-8110
(919) 776-0399
(910) 323-1144
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
448
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NC
106H00000X
Marriage & Family Therapist
448
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002X
BLUE CROSS PROVIDER
NC
01
—
11367606
CAQH
NC
01
—
14762257
UNITED HEALTHCARE
NC
05
—
6102267
—
NC
Enumeration date
05/25/2006
Last updated
09/11/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us