Provider Demographics
NPI:1073630513
Name:IACOCCA, DEMETRIA (LAADC, CADCII)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:IACOCCA
Suffix:
Gender:F
Credentials:LAADC, CADCII
Other - Prefix:
Other - First Name:DEMETRIA
Other - Middle Name:
Other - Last Name:ZAPPACOSTA-IACOCCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAADC, CADCII
Mailing Address - Street 1:110 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8352 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4449
Practice Address - Country:US
Practice Address - Phone:408-843-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)