Provider Demographics
NPI:1992056402
Name:CLARK, CAITLIN ALEXANDRA (BA, CADC I)
Entity type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:ALEXANDRA
Last Name:CLARK
Suffix:
Gender:F
Credentials:BA, CADC I
Other - Prefix:
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Mailing Address - Street 1:1199 N TERRY ST
Mailing Address - Street 2:180
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1459
Mailing Address - Country:US
Mailing Address - Phone:541-968-4282
Mailing Address - Fax:
Practice Address - Street 1:149 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6215
Practice Address - Country:US
Practice Address - Phone:541-484-9274
Practice Address - Fax:541-484-5021
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)