Healthcare Provider Details

I. General information

NPI: 1942187463
Provider Name (Legal Business Name): CHRISTY DALE LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S MAIN ST APT 1
PRINCETON IL
61356-2060
US

IV. Provider business mailing address

503 S MAIN ST APT 1
PRINCETON IL
61356-2060
US

V. Phone/Fax

Practice location:
  • Phone: 331-216-4477
  • Fax:
Mailing address:
  • Phone: 331-216-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: