1. Home
  2. Directory
  3. Virginia
  4. Fairfax
  5. Counselor
  6. NPI Profile

KEVIN CLARK
NPI 1245851104
Counselor - Addiction (Substance Use Disorder) in Fairfax, VA

Active since May 01, 2020
10615 JUDICIAL DR STE 403, FAIRFAX, VA 22030(703) 565-3783(571) 285-4001 Get Directions Write a Review

NPPES record last updated: April 26, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kevin Clark NPPES

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

KEVIN CLARK (NPI 1245851104) is an individual addiction (substance use disorder) provider in Fairfax, Virginia, licensed in Virginia (0710103244) and active in the NPI registry since May 2020.

NPPES Registry Identity

NPI1245851104
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameKEVIN CLARK
Location Address10615 JUDICIAL DR STE 403Fairfax, VA 22030-7501
Mailing Address7900 Scully CtManassas, VA 20111-8268 · (703) 477-4830
Phone(703) 565-3783
Fax(571) 285-4001
Sole ProprietorYes
Enumeration DateMay 1, 2020
Last NPPES UpdateApril 26, 2021
NPPES CertifiedApril 26, 2021
✔ NPI 1245851104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in VA · 0710103244
10615 JUDICIAL DR STE 403, Fairfax, VA 22030
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

AXIOMS HEALTH LLC
Clinic/Center (Adult Mental Health)
10615 JUDICIAL DR STE 403
FAIRFAX, VA 22030
Fairfax City (703) 495-3070

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 Kevin Clark's NPI number?

The NPI number for Kevin Clark is 1245851104. It was assigned to this individual provider in the NPPES registry on May 1, 2020.

Where is Kevin Clark located?

Kevin Clark practices at 10615 Judicial Dr Ste 403, Fairfax, VA 22030. The listed phone number is (703) 565-3783.

What is Kevin Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Kevin Clark was last updated on April 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.