Provider Demographics
NPI:1538949318
Name:DAHLBERG, CLIFF (MSW, LGSW, LADC)
Entity type:Individual
Prefix:
First Name:CLIFF
Middle Name:
Last Name:DAHLBERG
Suffix:
Gender:M
Credentials:MSW, LGSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7766 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2832
Mailing Address - Country:US
Mailing Address - Phone:763-205-4843
Mailing Address - Fax:
Practice Address - Street 1:7766 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2832
Practice Address - Country:US
Practice Address - Phone:763-205-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32328104100000X
MN306731101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker