Provider Demographics
NPI:1184904500
Name:NICCOLOCCI, LEAH SHALONA (LMHC, SUDP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SHALONA
Last Name:NICCOLOCCI
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 CORONA ST NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5201
Mailing Address - Country:US
Mailing Address - Phone:360-463-2553
Mailing Address - Fax:
Practice Address - Street 1:8929 CORONA ST NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5201
Practice Address - Country:US
Practice Address - Phone:360-463-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60097351101YA0400X
WALH60876786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)