Healthcare Provider Details

I. General information

NPI: 1376586503
Provider Name (Legal Business Name): C DAVID KUCHINSKI JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES DAVID KUCHINSKI

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/18/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 WEST 12TH STREET
LITTLE ROCK AR
72204-1509
US

IV. Provider business mailing address

PO BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-7233
  • Fax: 501-660-6834
Mailing address:
  • Phone: 501-666-8686
  • Fax: 501-660-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: