Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Autumn Rose Clark

Individual provider Professional Counselor · NPI 1528908688

Autumn Rose Clark is a Mental Health Counselor in Rome, Georgia. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in Georgia.

Years since qualifying
1
Licensed in
GA
In the registry since
2026

Practice location Address checks out

6095 Big Texas Valley Rd NW
Rome, GA 30165-9753
Phone: (619) 342-5933
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence APC010509 (GA)

Record details

NPI number1528908688
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 30, 2026
Last updated in NPPESMarch 30, 2026
Certification dateMarch 30, 2026
Mailing address6095 Big Texas Valley Rd Nw, Rome, GA 30165-9753

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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