Provider Demographics
NPI:1750601829
Name:FARACO, ALLICIA
Entity type:Individual
Prefix:MRS
First Name:ALLICIA
Middle Name:
Last Name:FARACO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALLICIA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAMFT
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:VERDI
Mailing Address - State:NV
Mailing Address - Zip Code:89439-0876
Mailing Address - Country:US
Mailing Address - Phone:530-807-7283
Mailing Address - Fax:
Practice Address - Street 1:1390 N. LAKE BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-386-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW2928101YA0400X
133NN1002X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education