Provider Demographics
NPI:1609521574
Name:DALE, KATRENA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:KATRENA
Middle Name:MARIE
Last Name:DALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 COUNTY ROAD 51 N
Mailing Address - Street 2:
Mailing Address - City:PINE APPLE
Mailing Address - State:AL
Mailing Address - Zip Code:36768-2609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 HORNADY DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-8658
Practice Address - Country:US
Practice Address - Phone:251-575-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5387G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical