Healthcare Provider Details

I. General information

NPI: 1619801545
Provider Name (Legal Business Name): DR. DIONNE NICHOLS-CONDOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 09/29/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9513 SWEET BAY LN
WESTWEGO LA
70094-3177
US

IV. Provider business mailing address

9513 SWEET BAY LN
WESTWEGO LA
70094-3177
US

V. Phone/Fax

Practice location:
  • Phone: 504-920-2166
  • Fax:
Mailing address:
  • Phone: 504-920-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: