Provider Demographics
NPI:1578810628
Name:CARO, DEBRA (MAC LAC DIPL AC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:CARO
Suffix:
Gender:F
Credentials:MAC LAC DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11732 DECADE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2945
Mailing Address - Country:US
Mailing Address - Phone:703-973-8581
Mailing Address - Fax:
Practice Address - Street 1:600 CARLISLE DR STE D
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4870
Practice Address - Country:US
Practice Address - Phone:703-973-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000674171100000X
MDUO1947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist