Individual provider · Type 1 NPI

Jerry Dean Clark, SUDP, CPSS

Addiction (Substance Use Disorder) Counselor · Centralia, WA

NPI number 1497232060 Active

Practice location

1126 S Gold St
Centralia, WA 98531-3714

Call (360) 827-4929 Map

Fax (844) 612-6673

Mailing address

PO Box 2394
Longview, WA 98632-8455

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XCP61099597 (WA)
Peer Specialist 175T00000XPR70101410 (WA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1497232060

Jerry Dean Clark, SUDP, CPSS's National Provider Identifier is 1497232060, issued on Jul 25, 2018. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Centralia, WA. The record was last updated on Aug 31, 2026.