Provider Demographics
NPI:1639300239
Name:WHITE, DALE DEAN (MBA, RRW)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:DEAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:MBA, RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 W SHAW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3706
Mailing Address - Country:US
Mailing Address - Phone:559-681-1947
Mailing Address - Fax:559-412-2126
Practice Address - Street 1:1204 W SHAW AVE # 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:559-681-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)