Rebecca Ann Clark, PHD, LCSW in Fort Moore, GA - Medicare Social Worker Provider

Rebecca Ann Clark, PHD, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Fort Moore, Georgia. Her current practice location is 6600 Van Aalst Blvd Bldg 9250, Fort Moore, Georgia. You can reach out to her office (for appointments etc.) via phone at (270) 535-2545.

Rebecca Ann Clark is licensed to practice in Georgia (license number CSW007735) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1699026773.

Contact Information

	Rebecca Ann Clark, PHD, LCSW
	6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905-2102
	(270) 535-2545
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Rebecca Ann Clark
Gender	Female
Speciality	Social Worker - Clinical
Location	6600 Van Aalst Blvd Bldg 9250, Fort Moore, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1699026773
Provider Enumeration Date: 09/28/2012
Last Update Date: 02/29/2024

Medicare PECOS Information:

PECOS PAC ID: 5395068621
Enrollment ID: I20220913000083

Medical Identifiers

Medical identifiers for Rebecca Ann Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1699026773	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	1151-3714C (Alabama)	Secondary
1041C0700X	Social Worker - Clinical	CSW007735 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Rebecca Ann Clark allows following entities to bill medicare on her behalf.

Entity Name	Agape Counseling Services, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1275290967 PECOS PAC ID: 1850775651 Enrollment ID: O20220829000409

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Rebecca Ann Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Rebecca Ann Clark, PHD, LCSW 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905-2102 Ph: (270) 535-2545	Rebecca Ann Clark, PHD, LCSW 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905-2102 Ph: (270) 535-2545

Reviews and Comments

Social Worker in Fort Moore, GA

Cindy Rosemarie Dad, MSW, LCSW, LAC Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd, Fort Moore, GA 31905 Phone: 762-408-2273
Jenna Irene Evans, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd, Fort Moore, GA 31905 Phone: 762-408-4073
Kendra Renee Bullocks, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 6600 Van Aalst Blvd, Fort Moore, GA 31905 Phone: 762-408-2273
Ms. Jessica Laurel Dawson, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905 Phone: 762-408-2273
Kellie Buck, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd, Fort Moore, GA 31905 Phone: 706-545-3172 Fax: 706-323-2564
Karnisha Harvey, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd, Fort Moore, GA 31905 Phone: 067-545-4995
Candice Kiera Gibson, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905 Phone: 762-408-4076

Rebecca Ann Clark, PHD, LCSW - Medicare Clinical Social Worker in Fort Moore, GA