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DEREK ELLIS CLARK LCSW
NPI 1710632278
Social Worker - Clinical in Fairfax, VA

Active since February 14, 2022
4100 MONUMENT CT UNIT 204, FAIRFAX, VA 22033(571) 393-2424 Get Directions Write a Review

NPPES record last updated: November 17, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 17, 2023, Feb 14, 2022 (2 updates tracked since 2022).

About Derek Ellis Clark Lcsw NPPES

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

DEREK ELLIS CLARK LCSW (NPI 1710632278) is an individual clinical provider in Fairfax, Virginia, licensed in Virginia (0904013710) and active in the NPI registry since February 2022.

NPPES Registry Identity

NPI1710632278
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameDEREK ELLIS CLARKCredential: LCSW
Location Address4100 MONUMENT CT UNIT 204Fairfax, VA 22033-2878
Mailing Address4100 Monument Ct Unit 204Fairfax, VA 22033-2878 · (703) 424-6788
Phone(571) 393-2424
Sole ProprietorYes
Enumeration DateFebruary 14, 2022
Last NPPES UpdateNovember 17, 20232 updates tracked since enumeration
NPPES CertifiedNovember 17, 2023
✔ NPI 1710632278 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in VA · 0904013710
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4100 MONUMENT CT UNIT 204, Fairfax, VA 22033
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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 Derek Clark's NPI number?

The NPI number for Derek Clark is 1710632278. It was assigned to this individual provider in the NPPES registry on February 14, 2022.

Where is Derek Clark located?

Derek Clark practices at 4100 Monument Ct Unit 204, Fairfax, VA 22033. The listed phone number is (571) 393-2424.

What is Derek Clark's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Derek Clark was last updated on November 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.