1760738231 NPI number — DALEKE COUNSELING AND CONSULTING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760738231 NPI number — DALEKE COUNSELING AND CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALEKE COUNSELING AND CONSULTING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760738231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 KORNEGAY RD
Provider Second Line Business Mailing Address:
REQ
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38606-7259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-609-1899
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 KORNEGAY RD
Provider Second Line Business Practice Location Address:
REQ
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38606-7259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-609-1899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DALEKE
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
662-609-1899

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C5591 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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