Healthcare Provider Details

I. General information

NPI: 1598923252
Provider Name (Legal Business Name): DONALD DALE GILBERT CADC I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2371 NE STEPHENS ST STE 200
ROSEBURG OR
97470-1399
US

IV. Provider business mailing address

2371 NE STEPHENS ST STE 200
ROSEBURG OR
97470-1399
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-8533
  • Fax: 541-672-4993
Mailing address:
  • Phone: 541-672-8533
  • Fax: 541-672-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4107360
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: