Provider Demographics
NPI:1225297161
Name:STOCKTON LEWIS, DARELL EUGENE (MA)
Entity Type:Individual
Prefix:MR
First Name:DARELL
Middle Name:EUGENE
Last Name:STOCKTON LEWIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-248-3047
Mailing Address - Fax:530-248-3006
Practice Address - Street 1:1880 SHASTA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0417
Practice Address - Country:US
Practice Address - Phone:530-248-3047
Practice Address - Fax:530-248-3006
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist