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

Kevin Clark

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1245851104

Kevin Clark is an Addiction (Substance Use Disorder) Counselor in Fairfax, Virginia. Practices as a sole proprietor. Licensed in Virginia.

Licensed in
VA
In the registry since
2020
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Practice location Address checks out

10615 Judicial Dr Ste 403
Fairfax, VA 22030-7501
Phone: (703) 565-3783
Fax: (571) 285-4001
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Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 0710103244 (VA)

Record details

NPI number1245851104
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 1, 2020
Last updated in NPPESApril 26, 2021
Certification dateApril 26, 2021
Mailing address7900 Scully Ct, Manassas, VA 20111-8268

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