Provider Demographics
NPI:1336315423
Name:DALE, DARIN (LCSW)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:DALE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 GREEN MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3622
Mailing Address - Country:US
Mailing Address - Phone:619-787-9935
Mailing Address - Fax:
Practice Address - Street 1:739 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1752
Practice Address - Country:US
Practice Address - Phone:619-787-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240941041C0700X
ORL46021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical