Individual
PROF. DALE MICHAEL MINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
8699 TERRELL ROAD, ATHENS, OH 45701-9325
(740) 592-5195
Mailing address
94 COLUMBUS ROAD, SUITE A4, ATHENS, OH 45701-1312
(740) 592-4615
(740) 592-4615
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0008212
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
061009
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12128803
CAQH
OH
Enumeration date
10/15/2010
Last updated
10/15/2010
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