Provider Demographics
NPI:1578078333
Name:HUMES, DALE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:HUMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 S MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3204
Mailing Address - Country:US
Mailing Address - Phone:814-807-0487
Mailing Address - Fax:888-538-2885
Practice Address - Street 1:996 S MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3204
Practice Address - Country:US
Practice Address - Phone:814-807-0487
Practice Address - Fax:888-538-2885
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
PAPC001095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional