Provider Demographics
NPI:1427646199
Name:FREDRICKSON, DALE CARL (MA, MDIV, PHD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:CARL
Last Name:FREDRICKSON
Suffix:
Gender:M
Credentials:MA, MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 VILLAGE SQUARE DR STE 307
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3692
Mailing Address - Country:US
Mailing Address - Phone:303-323-4722
Mailing Address - Fax:
Practice Address - Street 1:7505 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-3692
Practice Address - Country:US
Practice Address - Phone:303-323-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health