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

Derek Ellis Clark, LCSW

Individual provider Clinical Social Worker · NPI 1710632278

Derek Ellis Clark, LCSW is a Clinical Social Worker in Fairfax, Virginia. Practices as a sole proprietor. Licensed in Virginia.

Licensed in
VA
In the registry since
2022
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

4100 Monument Ct Unit 204
Fairfax, VA 22033-2878
Phone: (571) 393-2424
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 0904013710 (VA)

Record details

NPI number1710632278
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedFebruary 14, 2022
Last updated in NPPESNovember 17, 2023
Certification dateNovember 17, 2023

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