Provider Demographics
NPI:1518186626
Name:HOLLINGSHEAD, DALE THOMAS (MDIV, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:THOMAS
Last Name:HOLLINGSHEAD
Suffix:
Gender:M
Credentials:MDIV, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3713
Mailing Address - Country:US
Mailing Address - Phone:978-688-1081
Mailing Address - Fax:
Practice Address - Street 1:30 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1809
Practice Address - Country:US
Practice Address - Phone:978-683-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMH3161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health