Provider Demographics
NPI:1942641337
Name:MCCOY, DESIREE NADINE (ADJUNCT STAFF)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:NADINE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:ADJUNCT STAFF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 COURAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6717
Mailing Address - Country:US
Mailing Address - Phone:707-784-2128
Mailing Address - Fax:707-427-2981
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-784-2128
Practice Address - Fax:707-427-2981
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health