Provider Demographics
NPI:1467989376
Name:DALTON, ELIOT DEFOREST (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ELIOT
Middle Name:DEFOREST
Last Name:DALTON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W SICKLE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2844
Mailing Address - Country:US
Mailing Address - Phone:484-643-3704
Mailing Address - Fax:
Practice Address - Street 1:120 W SICKLE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2844
Practice Address - Country:US
Practice Address - Phone:484-643-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional