Provider Demographics
NPI:1033971890
Name:STOCKDALE, LAURA A (APCC PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:STOCKDALE
Suffix:
Gender:F
Credentials:APCC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 EXECUTIVE WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0634
Mailing Address - Country:US
Mailing Address - Phone:530-515-7946
Mailing Address - Fax:
Practice Address - Street 1:930 EXECUTIVE WAY STE 125
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0634
Practice Address - Country:US
Practice Address - Phone:530-515-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC15708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15708OtherBBS