Individual
MRS. CAITLIN VAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 672-2691
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
21-QMHP-R-0533
OR
1041C0700X
Clinical Social Worker
Primary
L11752
OR
Other
Enumeration date
02/26/2020
Last updated
02/27/2026
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