Provider Demographics
NPI:1194028381
Name:STEPHENS, SYDNEE KAE (SUDCC)
Entity type:Individual
Prefix:MS
First Name:SYDNEE
Middle Name:KAE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:SUDCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 RICHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307
Mailing Address - Country:US
Mailing Address - Phone:209-525-7411
Mailing Address - Fax:209-547-2083
Practice Address - Street 1:1904 RICHLAND AVE.
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307
Practice Address - Country:US
Practice Address - Phone:209-525-7411
Practice Address - Fax:209-547-2083
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS1306101650101YA0400X
UT7617574-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker