Provider Demographics
NPI:1487984837
Name:CLARK, AARON MIKEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:MIKEL
Last Name:CLARK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:571-284-3180
Mailing Address - Fax:571-284-3189
Practice Address - Street 1:15195 HEATHCOTE BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6242
Practice Address - Country:US
Practice Address - Phone:571-284-3180
Practice Address - Fax:571-284-3189
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical