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General NPI Number Information
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NPI Number | 1982936464
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Entity Type | Individual
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Provider Name | SUZANNE RENEE' ARK CACDI, LPC INTERN
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Gender | Female
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 460 LANCASTER DRIVE NE
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City | SALEM
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State | OR
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Zip | 97301
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Country | US
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Telephone | 503-584-1906
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Fax | 503-584-1952
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Provider Business Mailing Address
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Address Line | 460 LANCASTER DRIVE NE
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City | SALEM
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State | OR
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Zip | 97301
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Country | US
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Telephone | 503-584-1906
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Fax | 503-584-1952
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 02-03-09
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 02-03-09
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12-06-07
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R5063
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License Number State | OR
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