Provider Demographics
NPI:1427370139
Name:CLARKE, VALERIA LF (LCSW, CADC II)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:LF
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2315
Mailing Address - Country:US
Mailing Address - Phone:541-915-2690
Mailing Address - Fax:541-228-9370
Practice Address - Street 1:55 S 17TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424
Practice Address - Country:US
Practice Address - Phone:541-649-1877
Practice Address - Fax:541-228-9370
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09-12-59U101YA0400X
ORL47991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019047Medicaid