Healthcare Provider Details

I. General information

NPI: 1205833209
Provider Name (Legal Business Name): KATHY MOORE DICOLA MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 FAIRVIEW RD
CHARLOTTE NC
28210-3336
US

IV. Provider business mailing address

7210 APPLECREEK DR
CHARLOTTE NC
28227-5258
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-7777
  • Fax: 704-365-9256
Mailing address:
  • Phone: 704-545-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4178
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: