Healthcare Provider Details

I. General information

NPI: 1437182755
Provider Name (Legal Business Name): NZINGHA DALILA ED.D,PCC-S,LCOC-III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NZINGHA DALILA VICK PC

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 O'VARSITY WAY
CINCINNATI OH
45221-0001
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7700
  • Fax: 513-558-5055
Mailing address:
  • Phone: 513-585-6200
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDC.091004-3
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberE0500349
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLCDCIII091004
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0500349-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: