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NPI Code Detail

MEDICARE: KATHY MOORE DICOLA MA, LPC, NCC

MEDICARE: KATHY MOORE DICOLA MA, LPC, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor4178NC

General Provider Information

NPI Number : 1205833209
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY MOORE DICOLA MA, LPC, NCC
Provider Business Mailing Address
First Line : 7210 APPLECREEK DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-5258
Country : US
Telephone Number : 704-545-3624
Fax Number :
Provider Business Practice Location Address
First Line : 6809 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3336
Country : US
Telephone Number : 704-365-7777
Fax Number : 704-365-9256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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