Healthcare Provider Details

I. General information

NPI: 1992685119
Provider Name (Legal Business Name): DLC CARE CLINIC IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 AIRPORT FWY STE 214
HALTOM CITY TX
76117-5922
US

IV. Provider business mailing address

5208 AIRPORT FWY STE 214
HALTOM CITY TX
76117-5922
US

V. Phone/Fax

Practice location:
  • Phone: 682-499-5506
  • Fax:
Mailing address:
  • Phone: 682-499-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHARLES
Title or Position: OWNER
Credential:
Phone: 682-499-5506