Organization
CLARK COLLEGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA DOUGLASS LICSW (CLINICAL SUPERVISOR)
(360) 992-2614
Entity
Organization
Contact information
Practice address
1933 FORT VANCOUVER WAY, HSC 124, VANCOUVER, WA 98663-3529
(360) 992-2614
Mailing address
1933 FORT VANCOUVER WAY, HSC 124, VANCOUVER, WA 98663-3529
(360) 992-2614
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
PY60267694
WA
Other
Enumeration date
06/08/2014
Last updated
06/08/2014
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