Provider Demographics
NPI:1679221733
Name:WEBSTER, DENA D (RADT)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:D
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:FREDRICKSON-WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1530 3RD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD ST STE 111
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2501
Practice Address - Country:US
Practice Address - Phone:916-884-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1423670321101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)