Provider Demographics
NPI:1821019480
Name:STEDEFORD, WILLIAM CHRISTOPHER (MA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:STEDEFORD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PLACERVILLE DR
Mailing Address - Street 2:2
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4200
Mailing Address - Country:US
Mailing Address - Phone:530-644-2412
Mailing Address - Fax:530-644-8563
Practice Address - Street 1:670 PLACERVILLE DR
Practice Address - Street 2:2
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4200
Practice Address - Country:US
Practice Address - Phone:530-644-2412
Practice Address - Fax:530-644-8563
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 45677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDI-CAL PROVIDER NUMBER