Provider Demographics
NPI:1912542457
Name:PRINCE, STEPHEN LOCHRANE (ICADC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LOCHRANE
Last Name:PRINCE
Suffix:
Gender:M
Credentials:ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N SAN PEDRO RD STE 1015
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4155
Mailing Address - Country:US
Mailing Address - Phone:415-473-6612
Mailing Address - Fax:415-473-7509
Practice Address - Street 1:10 N SAN PEDRO RD STE 1015
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4155
Practice Address - Country:US
Practice Address - Phone:415-473-6618
Practice Address - Fax:415-473-7509
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)