| Doctor Name: | COCO DECARLO |
| NPI Number: | 1083083281 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | 08-30-16 |
| License Number: | R1213050915 |
| Business Practice Address: | 5607 Mount Murphy Rd Garden Valley, CA - 95633 |
| Business Phone Number: | 5303339460 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1666, PLACERVILLE |
| State: | CA |
| Postal Code: | 956671666 |
| Phone Number: | 5303339460 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2015 |
| NPI Last Update Date: | 09/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | R1213050915 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |