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1730676701
JACEY CLARK
LONGVIEW, WA
NPI
1730676701
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
(Licence: WA 60823909)
Enumeration Date
2018-04-16
Last Update Date
2019-05-01
Business Address
JACEY CLARK CDPT
720 14TH AVENUE
LONGVIEW, WA 98632
Phone number: 360-353-9840
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Mailing Address
JACEY CLARK CDPT
921 14TH AVENUE
LONGVIEW, WA 98632
Phone number: 360-423-0203
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