Provider Demographics
NPI:1063439594
Name:DALE, JOHN C (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:DALE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 MORRO RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3924
Mailing Address - Country:US
Mailing Address - Phone:805-466-5626
Mailing Address - Fax:805-466-2322
Practice Address - Street 1:8575 MORRO RD
Practice Address - Street 2:SUITE K
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3924
Practice Address - Country:US
Practice Address - Phone:805-466-5626
Practice Address - Fax:805-466-2322
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS145991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical