Provider Demographics
NPI:1023325396
Name:DICECCO, RACHAEL NADYNE
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NADYNE
Last Name:DICECCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:1313 FRYAR AVE UNIT 1025
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1798
Mailing Address - Country:US
Mailing Address - Phone:253-693-8588
Mailing Address - Fax:253-435-5980
Practice Address - Street 1:12515 MERIDIAN E STE 203
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:253-693-8588
Practice Address - Fax:253-435-5980
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health