Provider Demographics
NPI:1154103828
Name:KRZYZOPOLSKI, SHARAL MARLENA (SUDCC)
Entity type:Individual
Prefix:
First Name:SHARAL
Middle Name:MARLENA
Last Name:KRZYZOPOLSKI
Suffix:
Gender:F
Credentials:SUDCC
Other - Prefix:
Other - First Name:SHARAL
Other - Middle Name:MARLENA
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:228 SUTTON WAY UNIT D113
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4145
Mailing Address - Country:US
Mailing Address - Phone:530-648-6732
Mailing Address - Fax:
Practice Address - Street 1:256 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7239
Practice Address - Country:US
Practice Address - Phone:530-274-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)