Provider Demographics
NPI:1306013743
Name:DAHL, LUCINDA CARRIE (LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:CARRIE
Last Name:DAHL
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97011-0295
Mailing Address - Country:US
Mailing Address - Phone:503-545-8839
Mailing Address - Fax:
Practice Address - Street 1:65676 E SANDY RIVER LN
Practice Address - Street 2:
Practice Address - City:RHODODENDRON
Practice Address - State:OR
Practice Address - Zip Code:97049-9786
Practice Address - Country:US
Practice Address - Phone:503-545-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 601349131041C0700X
ORL29451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical