Provider Demographics
NPI:1487722047
Name:CLARK, JAMES W JR (LPC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:CLARK
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2324 VALLEYDALE RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2078
Mailing Address - Country:US
Mailing Address - Phone:256-239-5510
Mailing Address - Fax:256-489-2804
Practice Address - Street 1:7734 MADISON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2848
Practice Address - Country:US
Practice Address - Phone:256-239-5510
Practice Address - Fax:256-489-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6290016OtherUNITED BEHAVIORAL HEALTH
AL41437OtherBLUE CROSS