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General NPI Number Information
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NPI Number | 1760738231
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Entity Type | Organization
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Legal Business Name | DALEKE COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 209 KORNEGAY RD REQ
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City | BATESVILLE
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State | MS
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Zip | 38606-7259
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Country | US
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Telephone | 662-609-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 209 KORNEGAY RD REQ
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City | BATESVILLE
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State | MS
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Zip | 38606-7259
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Country | US
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Telephone | 662-609-1899
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. ROBIN DALEKE
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Credential | LCSW
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Telephone | 662-609-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C5591
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License Number State | MS
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