Provider Demographics
NPI:1609427970
Name:NILES, DELIA ANN (MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:ANN
Last Name:NILES
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:DELIA
Other - Middle Name:ANN
Other - Last Name:DIEGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW-A
Mailing Address - Street 1:3317 BURBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-6208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3317 BURBERRY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-6208
Practice Address - Country:US
Practice Address - Phone:910-638-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0140941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical