Provider Demographics
NPI:1396555454
Name:DIALS, CAINE THOMAS (LGSW)
Entity type:Individual
Prefix:
First Name:CAINE
Middle Name:THOMAS
Last Name:DIALS
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15074 SPRUCE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-4605
Mailing Address - Country:US
Mailing Address - Phone:304-928-6621
Mailing Address - Fax:
Practice Address - Street 1:386 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9202
Practice Address - Country:US
Practice Address - Phone:304-855-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker