Provider Demographics
NPI:1285230052
Name:TRUMM, STEPHANIE (RN, CARN, LAADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TRUMM
Suffix:
Gender:F
Credentials:RN, CARN, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DIAMOND PEAK DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7119
Mailing Address - Country:US
Mailing Address - Phone:916-849-4386
Mailing Address - Fax:916-987-2906
Practice Address - Street 1:103 DIAMOND PEAK DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7119
Practice Address - Country:US
Practice Address - Phone:916-849-4386
Practice Address - Fax:916-987-2906
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR02190816101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)