Provider Demographics
NPI:1740753995
Name:STATHOS, MARIA SOPHIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SOPHIA
Last Name:STATHOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 HEATHERDALE LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3523
Mailing Address - Country:US
Mailing Address - Phone:916-308-1536
Mailing Address - Fax:
Practice Address - Street 1:901 0 STREET
Practice Address - Street 2:SUITE C
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-497-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician