Individual
MR. TIMOTHY LESLIE DALLACQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
600 CENTRAL AVE, SUITE 305, GREAT FALLS, MT 59401-3179
(406) 868-8017
Mailing address
600 CENTRAL AVE, SUITE 305, GREAT FALLS, MT 59401-3179
(406) 868-8017
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
895
MT
Other
Enumeration date
04/27/2012
Last updated
03/31/2023
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