Provider Demographics
NPI:1689828709
Name:OLSEN, STEPHANIE MARIE (CADCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:CADCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68100 RAMON RD
Mailing Address - Street 2:B-10
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3387
Mailing Address - Country:US
Mailing Address - Phone:760-321-0870
Mailing Address - Fax:760-321-0916
Practice Address - Street 1:68100 RAMON RD
Practice Address - Street 2:B-10
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3387
Practice Address - Country:US
Practice Address - Phone:760-321-0870
Practice Address - Fax:760-321-0916
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)