Provider Demographics
NPI:1487389250
Name:CLARK, JAMES JACOB (LPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JACOB
Last Name:CLARK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:12351 DUTTON RD APT 1418
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4415
Mailing Address - Country:US
Mailing Address - Phone:718-249-6939
Mailing Address - Fax:
Practice Address - Street 1:12351 DUTTON RD APT 1418
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4415
Practice Address - Country:US
Practice Address - Phone:571-206-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022808101YM0800X
VA0701013896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health