Individual
TOD L DICECCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1418 LUISA ST, SANTA FE, NM 87505-4091
(505) 490-1984
Mailing address
PO BOX 8839, SANTA FE, NM 87504-8839
(505) 490-1984
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
9113
NC
101YP2500X
Professional Counselor
Primary
0119891
NM
101YP2500X
Professional Counselor
9113
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12324591
—
NM
05
—
3410049
—
NC
Enumeration date
06/04/2007
Last updated
10/15/2012
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