Provider Demographics
NPI:1205916269
Name:PARK, DENNIS CHAI SUN I (MA/MS, CADCIII, CDP)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:CHAI SUN
Last Name:PARK
Suffix:I
Gender:M
Credentials:MA/MS, CADCIII, CDP
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:CHAI SUN
Other - Last Name:PARK
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:MA/MS, CADCIII, CDP
Mailing Address - Street 1:PO BOX 1562
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-1500
Mailing Address - Country:US
Mailing Address - Phone:360-575-4818
Mailing Address - Fax:
Practice Address - Street 1:1230 7TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3166
Practice Address - Country:US
Practice Address - Phone:180-025-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP00005610OtherCHEMICAL DEPENDENCY WA