Provider Demographics
NPI:1699793307
Name:SEASTROM, TRISHA JANE (RADI)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:JANE
Last Name:SEASTROM
Suffix:
Gender:F
Credentials:RADI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LYND WAY
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3245
Mailing Address - Country:US
Mailing Address - Phone:707-678-4617
Mailing Address - Fax:
Practice Address - Street 1:3353 BRADSHAW RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2607
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)