Provider Demographics
NPI:1376042606
Name:STORMENT, CAROLINA LYNN (RATD)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINA
Middle Name:LYNN
Last Name:STORMENT
Suffix:
Gender:F
Credentials:RATD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1030 CALIFORNIA AVE # CA
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-2102
Mailing Address - Country:US
Mailing Address - Phone:209-550-7352
Mailing Address - Fax:209-521-7001
Practice Address - Street 1:1405 11TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0748
Practice Address - Country:US
Practice Address - Phone:209-284-0970
Practice Address - Fax:209-284-0971
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1240900117101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)