| Doctor Name: | MARILYN DALE |
| NPI Number: | 1003250242 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 6401000980 |
| Business Practice Address: | 4829 E Beltline Ave Ne Bldg 1, Upper Level Grand Rapids, MI - 495259747 |
| Business Phone Number: | 6163643301 |
| Business Fax Number: | 8663792151 |
| Mailing Address: | 4829 E Beltline Ave Ne, Bldg 1 GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495259747 |
| Phone Number: | 6163643120 |
| Fax Number: | 8663792151 |
| NPI Enumeration Date: | 04/18/2013 |
| NPI Last Update Date: | 04/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401000980 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |