MEDICARE: MRS. JEANA DEALENE DALE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11924-C	NV
2	1041C0700X	Clinical Social Worker	LICSW1141589	MA

General Provider Information

NPI Number	:	1366636250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANA DEALENE DALE LCSW

Provider Business Mailing Address
First Line	:	169 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-876-2375
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-876-2375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	03/19/2026

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