Provider Demographics
NPI:1760715148
Name:CLARK, LAURA MARIE (MSW, MA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW, MA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:STORM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, MA
Mailing Address - Street 1:3200 NE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7749
Mailing Address - Country:US
Mailing Address - Phone:360-695-1014
Mailing Address - Fax:
Practice Address - Street 1:3200 NE 109TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7749
Practice Address - Country:US
Practice Address - Phone:360-695-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical