Provider Demographics
NPI:1093303596
Name:DILELLA, NICOLE M (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:DILELLA
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 VALOR CT
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2509
Mailing Address - Country:US
Mailing Address - Phone:609-204-8830
Mailing Address - Fax:
Practice Address - Street 1:3712 OLD FOREST RD STE 400
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6959
Practice Address - Country:US
Practice Address - Phone:609-204-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional