MEDICARE: MS. NZINGHA DALILA ED.D,PCC-S,LCOC-III

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDC.091004-3	OH
2	103TC0700X	Clinical Psychologist	E0500349	OH
3	103TC1900X	Counseling Psychologist	LCDCIII091004	OH
4	101YP2500X	Professional Counselor	E.0500349-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000356242	OTHER	OH	ANTHEM PIN
2	174842311985	OTHER	OH	HUMANA ID

General Provider Information

NPI Number	:	1437182755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NZINGHA DALILA ED.D,PCC-S,LCOC-III

Provider Business Mailing Address
First Line	:	PO BOX 636256
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-6200
Fax Number	:	513-245-3672

Provider Business Practice Location Address
First Line	:	2751 O'VARSITY WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45221-0001
Country	:	US
Telephone Number	:	513-558-7700
Fax Number	:	513-558-5055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	06/12/2023

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