Provider Demographics
NPI:1093859928
Name:DICOLA, ELVIRA M (LPC)
Entity Type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:M
Last Name:DICOLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08005
Mailing Address - Country:US
Mailing Address - Phone:856-424-4408
Mailing Address - Fax:856-424-9164
Practice Address - Street 1:1868 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2031
Practice Address - Country:US
Practice Address - Phone:856-424-4408
Practice Address - Fax:856-424-9164
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00103400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040509Medicaid