Basic Information
| Provider Information | |||||||||
| NPI: | 1992935316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EICHENBERG | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492212749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172655352 | ||||||||
| FaxNumber: | 5172636090 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492212749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172655352 | ||||||||
| FaxNumber: | 5172636090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2009 | ||||||||
| LastUpdateDate: | 06/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401011293 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.