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Individual
KELLI JEANNE ROARK
Active
Individual
KELLI JEANNE ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, SUDP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60817555
WA
101YM0800X
Mental Health Counselor
Primary
LW60828872
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP60817555
SUBSTANCE USE DISORDER PROFESSIONAL CERTIFICATION
WA
01
—
LW60828872
SOCIAL WORKER INDEPENDENT CLINICAL LICENSE
WA
Enumeration date
05/24/2012
Last updated
03/24/2020
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