Healthcare Provider Details

I. General information

NPI: 1144158411
Provider Name (Legal Business Name): KDILLY FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 STATE ROAD 580 STE 111
CLEARWATER FL
33761-3352
US

IV. Provider business mailing address

2759 STATE ROAD 580 STE 111
CLEARWATER FL
33761-3352
US

V. Phone/Fax

Practice location:
  • Phone: 727-866-4682
  • Fax: 727-380-5684
Mailing address:
  • Phone: 727-866-4682
  • Fax: 727-380-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TRACY L SISK
Title or Position: EXECUTIVE/CLINICAL DIRECTOR
Credential: LMHC
Phone: 727-866-4682