Healthcare Provider Details

I. General information

NPI: 1851573604
Provider Name (Legal Business Name): STEVEN DEQUEANT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W ARKANSAS LN SUITE 116
ARLINGTON TX
76016-1272
US

IV. Provider business mailing address

PO BOX 175195
ARLINGTON TX
76003-5195
US

V. Phone/Fax

Practice location:
  • Phone: 817-875-6693
  • Fax:
Mailing address:
  • Phone: 817-875-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15165
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: