| Doctor Name: | DEADRA D. CARRILLO |
| NPI Number: | 1023154085 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. LPC |
| License Number: | 0510 |
| Business Practice Address: | 333 Road 4990 Bloomfield, NM - 874139626 |
| Business Phone Number: | 5056326713 |
| Business Fax Number: | |
| Mailing Address: | 333 Road 4990, BLOOMFIELD |
| State: | NM |
| Postal Code: | 874139626 |
| Phone Number: | 5056326713 |
| Fax Number: | |
| NPI Enumeration Date: | 01/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0510 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |