Provider Demographics
NPI:1891137733
Name:DALE, HEATHER JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOY
Last Name:DALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ROSEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1628
Mailing Address - Country:US
Mailing Address - Phone:949-278-2204
Mailing Address - Fax:
Practice Address - Street 1:3500 ROSEHEDGE DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1628
Practice Address - Country:US
Practice Address - Phone:949-278-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 270231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical