Provider Demographics
NPI:1376586503
Name:KUCHINSKI, C DAVID JR (LCSW)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:DAVID
Last Name:KUCHINSKI
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:DAVID
Other - Last Name:KUCHINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1970
Mailing Address - Country:US
Mailing Address - Phone:501-666-8686
Mailing Address - Fax:501-660-6830
Practice Address - Street 1:6425 WEST 12TH STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1509
Practice Address - Country:US
Practice Address - Phone:501-666-7233
Practice Address - Fax:501-660-6834
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T378Medicare PIN