Provider Demographics
NPI:1851001440
Name:DICOSTANZO, GALE CLARA
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:CLARA
Last Name:DICOSTANZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DILLON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARTENBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304
Mailing Address - Country:US
Mailing Address - Phone:864-582-7588
Mailing Address - Fax:864-562-4117
Practice Address - Street 1:129 DILLON DRIVE
Practice Address - Street 2:
Practice Address - City:SPARTENBURG
Practice Address - State:SC
Practice Address - Zip Code:29304
Practice Address - Country:US
Practice Address - Phone:864-582-7588
Practice Address - Fax:864-562-4117
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD10SPMedicaid