Healthcare Provider Details

I. General information

NPI: 1922501998
Provider Name (Legal Business Name): CARL ALBERT ROBINSON SUDP, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 GRAND BLVD
VANCOUVER WA
98661-4630
US

IV. Provider business mailing address

2410 GRAND BLVD
VANCOUVER WA
98661-4630
US

V. Phone/Fax

Practice location:
  • Phone: 360-729-7037
  • Fax:
Mailing address:
  • Phone: 360-369-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.61079474
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70087764
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBHA.FS.61435115
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSS.PR.70055480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: