Healthcare Provider Details

I. General information

NPI: 1386413318
Provider Name (Legal Business Name): WALTER ARDEN DUNN LSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 PA RTE-390
CRESCO PA
18326-1843
US

IV. Provider business mailing address

1441 LAKE ARIEL HWY
LAKE ARIEL PA
18436-4204
US

V. Phone/Fax

Practice location:
  • Phone: 570-269-8812
  • Fax:
Mailing address:
  • Phone: 570-269-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14849
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW139660
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: