Provider Demographics
NPI:1265149363
Name:DALE, LATEASA M (CD, CLC)
Entity type:Individual
Prefix:
First Name:LATEASA
Middle Name:M
Last Name:DALE
Suffix:
Gender:F
Credentials:CD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 10TH AVE N APT 101
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6747
Mailing Address - Country:US
Mailing Address - Phone:561-316-6119
Mailing Address - Fax:
Practice Address - Street 1:2781 10TH AVE N APT 101
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-6747
Practice Address - Country:US
Practice Address - Phone:561-316-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula