Provider Demographics
NPI:1770778474
Name:DALE, AMANDA (MS, MFTI)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:DALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFTI
Mailing Address - Street 1:1370 BREA BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4125
Mailing Address - Country:US
Mailing Address - Phone:800-998-6329
Mailing Address - Fax:866-558-7507
Practice Address - Street 1:101 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3256
Practice Address - Country:US
Practice Address - Phone:800-998-6329
Practice Address - Fax:866-558-7507
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist