Individual
JUSTIN DALLACQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
J.D., PSY.D.
Contact information
Practice address
408 N KENDRICK ST, SUITE 3, FLAGSTAFF, AZ 86001-1582
(602) 456-2148
Mailing address
761 E UNIVERSITY DR, SUITE G, MESA, AZ 85203-7961
(602) 456-2148
(480) 718-8619
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4681
AZ
Other
Enumeration date
12/04/2015
Last updated
12/04/2015
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