Active NPI
Dianne E Mollica, LMHC
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1760726541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH10969
- Practice address
- 4250 Lakeside Dr
Aging True
Jacksonville, FL 32210-3358 - Phone
- (904) 807-1249
- NPI assigned
- Nov 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH10969 | FL | Primary |
Addresses
Primary practice location
4250 Lakeside Dr
Aging True
Jacksonville, FL 32210-3358
Mailing address
4250 Lakeside Dr
Jacksonville, FL 32210-3358
Phone (904) 738-3334
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH10969 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1760726541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4250 LAKESIDE DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322103358",
"telephone_number": "904-738-3334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 LAKESIDE DR",
"address_2": "AGING TRUE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322103358",
"telephone_number": "904-807-1249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLLICA",
"first_name": "DIANNE",
"middle_name": "E",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-19",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH10969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.