Provider Demographics
NPI:1003090713
Name:DESHAZO, DARCIE CAROLINE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:DARCIE
Middle Name:CAROLINE
Last Name:DESHAZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PAYTON GIN RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6506
Mailing Address - Country:US
Mailing Address - Phone:512-836-2150
Mailing Address - Fax:512-836-2159
Practice Address - Street 1:1600 PAYTON GIN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6506
Practice Address - Country:US
Practice Address - Phone:512-836-2150
Practice Address - Fax:512-836-2159
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40603104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker