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Jerry Dean Clark, SUDR,CPC,AAC
Addiction (Substance Use Disorder) Counselor in Centralia, Washington
NPI 1497232060

Jerry Dean Clark is an Addiction (Substance Use Disorder) Counselor based in Longview, WA and is specialized in Addiction (Substance Use Disorder). Jerry Dean Clark practices in Centralia, WA and has the professional credentials of SUDR,CPC,AAC. The NPI Number for Jerry Dean Clark is 1497232060 and holds a License No. CG60783169 (Washington).

The current practice location address for Jerry Dean Clark is 1616 S Gold St Ste 4, Centralia, WA and can be reached out via phone at 360-807-4929.

Location: 1616 S Gold St Ste 4, Centralia, WA, 98632
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1497232060
Provider Name
Jerry Dean Clark
Credential
SUDR,CPC,AAC
Provider Entity Type
Individual
Gender
Male
Address
1616 S Gold St Ste 4, Centralia, WA, 98632
Phone Number
360-807-4929
Fax Number
Provider Enumeration Date
07/25/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1616 S Gold St Ste 4
City
Centralia
State
Washington
Zip
98531-8930
Phone Number
360-807-4929
Fax Number
person
Provider Business Mailing Address Details
Address
1616 S Gold St Ste 4
City
Centralia
State
Washington
Zip
98531-8930
Phone Number
360-807-4929
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
(Washington)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
CG60783169 (Washington)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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