Provider Demographics
NPI:1659762805
Name:DUCHNICK, DALLAS DANIEL (BS BEHAVIORAL HEALTH)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:DANIEL
Last Name:DUCHNICK
Suffix:
Gender:M
Credentials:BS BEHAVIORAL HEALTH
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:29201 HEATHERCLIFF RD
Mailing Address - Street 2:#149
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4146
Mailing Address - Country:US
Mailing Address - Phone:888-456-2528
Mailing Address - Fax:
Practice Address - Street 1:29201 HEATHERCLIFF RD
Practice Address - Street 2:#149
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4146
Practice Address - Country:US
Practice Address - Phone:888-456-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health