Provider Demographics
NPI:1235437757
Name:DALL, CHELSE BETH (MS, CCDP, CAC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:CHELSE
Middle Name:BETH
Last Name:DALL
Suffix:
Gender:F
Credentials:MS, CCDP, CAC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2033
Mailing Address - Country:US
Mailing Address - Phone:203-598-9361
Mailing Address - Fax:203-533-5507
Practice Address - Street 1:357 STATE ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2033
Practice Address - Country:US
Practice Address - Phone:203-598-9361
Practice Address - Fax:203-533-5507
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000878101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)