Provider Demographics
NPI:1710062286
Name:DENICOLO, DENISE KATHARINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:KATHARINE
Last Name:DENICOLO
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 1:325 WHITESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6046
Mailing Address - Country:US
Mailing Address - Phone:210-414-6445
Mailing Address - Fax:
Practice Address - Street 1:18534 FORTY-SIX PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070
Practice Address - Country:US
Practice Address - Phone:210-864-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62307101YP2500X
TX10273101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
11846935OtherCAQH