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General NPI Number Information
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NPI Number | 1306309513
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Entity Type | Individual
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Provider Name | KACEY DECOT CDCA II
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Gender | Female
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Dates
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Enumeration Date | 04/13/2019
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 196 E EMMITT AVE
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City | WAVERLY
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State | OH
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Zip | 45690
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Country | US
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Telephone | 740-343-3437
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Fax |
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Provider Business Mailing Address
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Address Line | 310 MADISON ST
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City | OAK HILL
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State | OH
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Zip | 45656-1208
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Country | US
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Telephone | 740-343-3437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 171381
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | QMHS
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CMS
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 175617
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License Number State | OH
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