Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelli Jeanne Roark, LICSW, SUDP

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1568722445

Kelli Jeanne Roark, LICSW, SUDP is an Addiction (Substance Use Disorder) Counselor in Arlington, Washington. Licensed in Washington. Registered with an NPI since 2012.

Licensed in
WA
In the registry since
2012
Specialties on file
2
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

4511 188th St NE
Arlington, WA 98223-7778
Phone: (425) 231-7589
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LW60828872 (WA)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence CP60817555 (WA)

Record details

NPI number1568722445
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW , SUDP
Sole proprietorNo
NPI enumeratedMay 24, 2012
Last updated in NPPESMarch 24, 2020
Certification dateMarch 24, 2020

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