Provider Demographics
NPI:1851644363
Name:GOOD, STEPHANIE RENE (CATC I)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENE
Last Name:GOOD
Suffix:
Gender:F
Credentials:CATC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8665 GIBBS DR.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1845
Mailing Address - Country:US
Mailing Address - Phone:858-384-6284
Mailing Address - Fax:
Practice Address - Street 1:8665 GIBBS DR STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1739
Practice Address - Country:US
Practice Address - Phone:858-384-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)