Provider Demographics
NPI:1073012480
Name:NEWSOME, STACEY RAE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RAE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-7318
Mailing Address - Country:US
Mailing Address - Phone:530-923-5610
Mailing Address - Fax:
Practice Address - Street 1:1745 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-7318
Practice Address - Country:US
Practice Address - Phone:530-923-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)