Provider Demographics
NPI:1881269686
Name:ATISON, DALE
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:ATISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2316
Mailing Address - Country:US
Mailing Address - Phone:216-303-2745
Mailing Address - Fax:
Practice Address - Street 1:1710 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2322
Practice Address - Country:US
Practice Address - Phone:216-781-3773
Practice Address - Fax:216-781-2023
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.176807101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)