Provider Demographics
NPI:1770734063
Name:EILERMAN, DALE J (PCC-S)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:EILERMAN
Suffix:
Gender:M
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3797 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2034
Mailing Address - Country:US
Mailing Address - Phone:937-219-4996
Mailing Address - Fax:
Practice Address - Street 1:2670 WOODMAN CENTER CT
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1477
Practice Address - Country:US
Practice Address - Phone:937-219-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health