Provider Demographics
NPI:1386413318
Name:DUNN, WALTER ARDEN (LSW, CADC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:ARDEN
Last Name:DUNN
Suffix:
Gender:M
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 LAKE ARIEL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4204
Mailing Address - Country:US
Mailing Address - Phone:570-269-8812
Mailing Address - Fax:
Practice Address - Street 1:1056 PA RTE-390
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326-1843
Practice Address - Country:US
Practice Address - Phone:570-269-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14849101YA0400X
PASW139660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty