Individual
MARK DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
576 W 900 S, WOODS CROSS, UT 84010-8194
(801) 397-4166
Mailing address
576 W 900 S, WOODS CROSS, UT 84010-8194
(801) 397-4166
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
286590-3501
UT
Other
Enumeration date
09/18/2020
Last updated
09/18/2020
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