Provider Demographics
NPI:1982263539
Name:DALRYMPLE, CHARLES ANDREW JR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:DALRYMPLE
Suffix:JR
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 1:305 WASHINGTON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4773
Mailing Address - Country:US
Mailing Address - Phone:219-309-9952
Mailing Address - Fax:
Practice Address - Street 1:2005 VALPARAISO ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3329
Practice Address - Country:US
Practice Address - Phone:219-252-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002958A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health