Provider Demographics
NPI:1265759294
Name:DALE, CHARLES JR (BS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:DALE
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W. 10TH STREET
Mailing Address - Street 2:GUADENZIA FRESH START
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:302-737-4100
Mailing Address - Fax:302-656-1294
Practice Address - Street 1:604 W 10TH ST
Practice Address - Street 2:GUADENZIA FRESH START
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1424
Practice Address - Country:US
Practice Address - Phone:302-737-4100
Practice Address - Fax:302-656-1294
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)