Provider Information for 1487161279
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JEREMIAH DALTON LPC
Sex: Male
NPI: 1487161279
Last Updated: 2018-01-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1487161279 | ||||||||
| Enumeration Date | 2018-01-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 706 N CHEROKEE AVE DOTHAN, AL 36303-3113 United States Phone: 334-796-1485 | Fax: | ||||||||
| Primary Practice Address | 706 N CHEROKEE AVE DOTHAN, AL 36303-3113 United States Phone: 334-796-1485 | Fax: | ||||||||
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