Provider Demographics
NPI:1013033596
Name:DALE, VALLA JEAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:VALLA
Middle Name:JEAN
Last Name:DALE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24301 SOUTHLAND DR
Mailing Address - Street 2:SUITE 605B
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1542
Mailing Address - Country:US
Mailing Address - Phone:510-757-7777
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR
Practice Address - Street 2:SUITE 605B
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1542
Practice Address - Country:US
Practice Address - Phone:510-757-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38855106H00000X
CALPCC573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist