Provider Demographics
NPI:1053933549
Name:PICKETT, DALE III (MS, NCC)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:PICKETT
Suffix:III
Gender:M
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 E LEE HWY
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:VA
Mailing Address - Zip Code:22844-3221
Mailing Address - Country:US
Mailing Address - Phone:540-333-4728
Mailing Address - Fax:
Practice Address - Street 1:333 WINDERMERE DR
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9489
Practice Address - Country:US
Practice Address - Phone:540-333-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health