Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 40603 | TX |
NPI | 1003090713 |
---|---|
Provider Name | Miss Darcie Caroline Deshazo |
First Address | Austin, TX 78758-6506 |
Second Address | Austin, TX 78758-6506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 18/12/2007 |