Healthcare Provider Details

I. General information

NPI: 1275964678
Provider Name (Legal Business Name): DANIELLE LYNNE CICCONE MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE LYNNE JOEL

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30101 AGOURA CT STE 111
AGOURA HILLS CA
91301-4301
US

IV. Provider business mailing address

30101 AGOURA CT STE 111
AGOURA HILLS CA
91301-4301
US

V. Phone/Fax

Practice location:
  • Phone: 818-658-2137
  • Fax:
Mailing address:
  • Phone: 818-658-2137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC4677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: