Provider Demographics
NPI:1386825883
Name:RADICH, SHEVONNE MARIE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:SHEVONNE
Middle Name:MARIE
Last Name:RADICH
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841 WILLIAMSON DR STE 40
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1800
Mailing Address - Country:US
Mailing Address - Phone:916-685-5258
Mailing Address - Fax:
Practice Address - Street 1:8841 WILLIAMSON DR STE 40
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1800
Practice Address - Country:US
Practice Address - Phone:916-685-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAMFC53873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)