Provider Demographics
NPI:1992026462
Name:BROTHERTON, WILLIAM DALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DALE
Last Name:BROTHERTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 KILLIAN BLDG. LANE
Mailing Address - Street 2:204A KILLIAN BLDG.
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723
Mailing Address - Country:US
Mailing Address - Phone:828-227-3284
Mailing Address - Fax:828-227-7021
Practice Address - Street 1:91 KILLIAN BLDG. LANE
Practice Address - Street 2:204A KILLIAN BLDG.
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723
Practice Address - Country:US
Practice Address - Phone:828-227-3284
Practice Address - Fax:828-227-7021
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional