Provider Demographics
NPI:1932513009
Name:STOCKSDALE, KAREN (MA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:STOCKSDALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3324
Mailing Address - Country:US
Mailing Address - Phone:707-217-1333
Mailing Address - Fax:
Practice Address - Street 1:1625 TERRACE WAY
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3035
Practice Address - Country:US
Practice Address - Phone:707-217-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50508101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor