Provider Demographics
NPI:1386040202
Name:STONE, ADELINA (AII16011018)
Entity Type:Individual
Prefix:
First Name:ADELINA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:AII16011018
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4818
Mailing Address - Country:US
Mailing Address - Phone:916-974-8090
Mailing Address - Fax:916-974-7851
Practice Address - Street 1:6127 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4818
Practice Address - Country:US
Practice Address - Phone:916-974-8090
Practice Address - Fax:916-974-7851
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII16011018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)