Provider Demographics
NPI:1558612952
Name:DOUCETTE, STEPHANIE C (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 ADDISON ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1651
Mailing Address - Country:US
Mailing Address - Phone:510-495-5752
Mailing Address - Fax:
Practice Address - Street 1:1139 ADDISON ST
Practice Address - Street 2:UNIT 2
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1651
Practice Address - Country:US
Practice Address - Phone:510-495-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12366171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist