Healthcare Provider Details

I. General information

NPI: 1609521574
Provider Name (Legal Business Name): KATRENA MARIE DALE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HORNADY DR
MONROEVILLE AL
36460-8658
US

IV. Provider business mailing address

219 COUNTY ROAD 51 N
PINE APPLE AL
36768-2609
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-4837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5387G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: