SHAMIA CLARK LCPC
NPI 1104615921
Counselor - Mental Health in Baltimore, MD
About Shamia Clark Lcpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHAMIA CLARK LCPC (NPI 1104615921) is an individual mental health provider in Baltimore, Maryland, licensed in Maryland (LC15913) and active in the NPI registry since May 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shamia Clark Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Shamia Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Baltimore, MD 21218
- Reassigned Medicare billing, Maryland enrollment
- Medicare enrollment name: Intentional Minds L.Lc
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Shamia Clark's NPI number?
The NPI number for Shamia Clark is 1104615921. It was assigned to this individual provider in the NPPES registry on May 6, 2025.
Where is Shamia Clark located?
Shamia Clark practices at 3608 Old York Rd, Baltimore, MD 21218. The listed phone number is (443) 455-0786.
What is Shamia Clark's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Shamia Clark enrolled in Medicare?
Yes. Shamia Clark is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Shamia Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shamia Clark reassigns Medicare benefits to Intentional Minds L.L.C (Baltimore, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shamia Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Shamia Clark was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.
# Shamia Clark, LCPC · NPI 1104615921
Mental Health provider in Baltimore, Maryland. Individual provider, active in the CMS NPPES registry since May 6, 2025.
## Identity
- **NPI:** 1104615921 (Entity type: Individual)
- **Enumerated:** May 6, 2025
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** LC15913 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 3608 OLD YORK RD, Baltimore, MD 21218-2546
- **Phone:** (443) 455-0786
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Intentional Minds L.L.C (NPI 1437030681, Baltimore, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** September 11, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1104615921) · Data from the CMS NPPES public registry.