=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396013926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALE A ENGLISH MS CAS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2011
-----------------------------------------------------
Last Update Date | 12/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 MARKET ST COMMUNITY COUSELING
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18013-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-588-9109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 1 BOX 819
-----------------------------------------------------
City | DINGMANS FERRY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18328-9753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-242-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------