Provider Demographics
NPI:1437529716
Name:FINCH, DALLAS ALLEN (RCSWI)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:ALLEN
Last Name:FINCH
Suffix:
Gender:M
Credentials:RCSWI
Other - Prefix:
Other - First Name:DALLAS-PATRICK
Other - Middle Name:ALLEN
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RCSWI
Mailing Address - Street 1:752 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2524
Mailing Address - Country:US
Mailing Address - Phone:850-747-8144
Mailing Address - Fax:850-747-0197
Practice Address - Street 1:752 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2524
Practice Address - Country:US
Practice Address - Phone:850-747-8144
Practice Address - Fax:850-747-0197
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW8176104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW8176OtherFLORIDA LICENSE