Provider Demographics
NPI:1437356185
Name:CODY, DARCEL
Entity Type:Individual
Prefix:
First Name:DARCEL
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 WOODLAND SQUARE LOOP SE
Mailing Address - Street 2:STE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1000
Mailing Address - Country:US
Mailing Address - Phone:360-352-4960
Mailing Address - Fax:360-455-4184
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:STE D
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-352-4960
Practice Address - Fax:360-455-4184
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00054684101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor