Healthcare Provider Details

I. General information

NPI: 1659652139
Provider Name (Legal Business Name): JACQUELINE DELPHINE DI GIACOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 SUTTER AVE THE WHITE HOUSE COUNSELING CENTER
CARMICHAEL CA
95608-2738
US

IV. Provider business mailing address

6147 SUTTER AVE THE WHITE HOUSE COUNSELING CENTER
CARMICHAEL CA
95608-2738
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7640
  • Fax: 916-971-5711
Mailing address:
  • Phone: 916-971-7640
  • Fax: 916-971-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number72213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: