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General NPI Number Information
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NPI Number | 1447601463
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Entity Type | Individual
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Provider Name | DUSTIN HALLIWELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 530 COMMUNINCATION CIR.
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-4263
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Country | US
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Telephone | 562-221-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 6541 SPECKER AVE BLDG 1830
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City | COLORADO SPRINGS
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State | CO
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Zip | 80913-4263
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Country | US
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Telephone | 719-503-7922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW09926366
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License Number State | CO
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