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General NPI Number Information
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NPI Number | 1992685119
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Entity Type | Organization
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Legal Business Name | DLC CARE CLINIC IV, LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 5208 AIRPORT FWY STE 214
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City | HALTOM CITY
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State | TX
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Zip | 76117-5922
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Country | US
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Telephone | 682-499-5506
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Fax |
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Provider Business Mailing Address
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Address Line | 5208 AIRPORT FWY STE 214
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City | HALTOM CITY
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State | TX
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Zip | 76117-5922
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Country | US
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Telephone | 682-499-5506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID CHARLES
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Credential |
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Telephone | 682-499-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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