Healthcare Provider Details

I. General information

NPI: 1265712673
Provider Name (Legal Business Name): NICOLE DELLI PAOLI LMHC, MCAP, QS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 05/24/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3943 NEW RIVER HILLS PKWY
VALRICO FL
33596
US

IV. Provider business mailing address

PO BOX 6531
BRANDON FL
33508-6009
US

V. Phone/Fax

Practice location:
  • Phone: 813-421-3031
  • Fax:
Mailing address:
  • Phone: 813-421-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP100211
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: