Healthcare Provider Details

I. General information

NPI: 1316868698
Provider Name (Legal Business Name): ALICIA DENICOLA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA ORY

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 HWY 101
FLORENCE OR
97439
US

IV. Provider business mailing address

892 32ND PLACE
FLORENCE OR
97439
US

V. Phone/Fax

Practice location:
  • Phone: 541-997-3212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number576555
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: