Provider Demographics
NPI:1083093728
Name:STORY, TRICIA MARIE (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:MARIE
Last Name:STORY
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODSTOCK WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1111
Mailing Address - Country:US
Mailing Address - Phone:916-272-9100
Mailing Address - Fax:
Practice Address - Street 1:1900 WOODSTOCK WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1111
Practice Address - Country:US
Practice Address - Phone:916-272-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC040830217101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)