KRISTINA M CLARK LPC
NPI 1083173702
Counselor - Mental Health in Charleston, WV

Q: What is Kristina Clark's NPI number?

The NPI number for Kristina Clark is 1083173702. It was assigned to this individual provider in the NPPES registry on March 13, 2019.

Q: What is Kristina Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Kristina Clark was last updated on September 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 13, 2019PECOS EnrolledAccepts Medicare Assignment

511 MORRIS ST, CHARLESTON, WV 25301(304) 525-7851(304) 525-1073 Get Directions Write a Review

NPPES record last updated: September 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 5, 2024, Jul 9, 2024, Mar 13, 2019 (3 updates tracked since 2019).

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About Kristina M Clark Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KRISTINA M CLARK LPC (NPI 1083173702) is an individual mental health provider in Charleston, West Virginia, licensed in West Virginia (2398) and active in the NPI registry since March 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1083173702

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameKRISTINA M CLARKCredential: LPC

Location Address511 MORRIS STCharleston, WV 25301-1326

Mailing Address99 Cracker Barrel Dr Ste 100Barboursville, WV 25504-1650 · (304) 525-7851 · Fax (304) 525-1073

Phone(304) 525-7851

Fax(304) 525-1073

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateMarch 13, 2019

Last NPPES UpdateSeptember 5, 20243 updates tracked since enumeration

NPPES CertifiedSeptember 5, 2024

✔ NPI 1083173702 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in WV · 2398

511 MORRIS ST, Charleston, WV 25301

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, Highmark Blue Cross Blue Shield West Virginia.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kristina M Clark Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2264873066

PECOS Enrollment IDI20240510001556

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DOROTHY THOMAS LGSW

Social Worker (Clinical)