Provider Demographics
NPI:1801867460
Name:DALE, JAMES (CAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DALE
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13121 BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1514
Mailing Address - Country:US
Mailing Address - Phone:301-733-0331
Mailing Address - Fax:301-733-4038
Practice Address - Street 1:13215 BROOK LANE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1514
Practice Address - Country:US
Practice Address - Phone:301-733-0331
Practice Address - Fax:301-733-4038
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0730101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD698800800Medicaid
MD986965400Medicaid