MEDICARE: DWIGHT HALE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1932721438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWIGHT HALE

Provider Business Mailing Address
First Line	:	3720 NYMUE PT APT 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4553
Country	:	US
Telephone Number	:	419-297-6294
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 NYMUE PT APT 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4553
Country	:	US
Telephone Number	:	419-297-6294
Fax Number	:

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

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	08/30/2024

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Directions to “ DWIGHT HALE ” Practice Location

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