Healthcare Provider Details

I. General information

NPI: 1912304080
Provider Name (Legal Business Name): ANNALICIA DILOLLO MS, LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S 4TH ST APT A
GETTYSBURG PA
17325-2001
US

IV. Provider business mailing address

16 S 4TH ST APT A
GETTYSBURG PA
17325-2001
US

V. Phone/Fax

Practice location:
  • Phone: 833-472-4267
  • Fax:
Mailing address:
  • Phone: 833-472-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9681
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011024
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014022
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0014404
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: