1659652139 NPI number — JACQUELINE DELPHINE DI GIACOMO

Table of content: JACQUELINE DELPHINE DI GIACOMO (NPI 1659652139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659652139 NPI number — JACQUELINE DELPHINE DI GIACOMO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DI GIACOMO
Provider First Name:
JACQUELINE
Provider Middle Name:
DELPHINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659652139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6147 SUTTER AVE
Provider Second Line Business Mailing Address:
THE WHITE HOUSE COUNSELING CENTER
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-971-7640
Provider Business Mailing Address Fax Number:
916-971-5711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6147 SUTTER AVE
Provider Second Line Business Practice Location Address:
THE WHITE HOUSE COUNSELING CENTER
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-971-7640
Provider Business Practice Location Address Fax Number:
916-971-5711
Provider Enumeration Date:
08/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 72213 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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