Provider Demographics
NPI:1265736508
Name:CLARK, KEVIN (DAOM, LAC, NCC, EMDR)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:DAOM, LAC, NCC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1808
Mailing Address - Country:US
Mailing Address - Phone:302-249-0143
Mailing Address - Fax:
Practice Address - Street 1:543 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1808
Practice Address - Country:US
Practice Address - Phone:302-249-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2025-000205101YA0400X
NJ25MZ00104200171100000X
DECQ-0000029171100000X
NJ37AC00916700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional