Provider Demographics
NPI:1811539257
Name:MCCALLISTER, DALE CALVIN (LPCA)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:CALVIN
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 LITTLEJOHN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5517
Mailing Address - Country:US
Mailing Address - Phone:910-346-8504
Mailing Address - Fax:
Practice Address - Street 1:221 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4736
Practice Address - Country:US
Practice Address - Phone:910-378-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC980729101YS0200X
NCA14157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA14157OtherNC BOARD OF LICENSED PROFESSIONAL COUNSELORS