Provider Demographics
NPI:1720161573
Name:STICKLEY, STEPHANIE ANN (M F C C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:STICKLEY
Suffix:
Gender:F
Credentials:M F C C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFCC
Mailing Address - Street 1:P.O. BOX 714
Mailing Address - Street 2:
Mailing Address - City:EL VERANO
Mailing Address - State:CA
Mailing Address - Zip Code:95433-0714
Mailing Address - Country:US
Mailing Address - Phone:707-953-2803
Mailing Address - Fax:
Practice Address - Street 1:159 FETTERS AVENUE
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3496
Practice Address - Country:US
Practice Address - Phone:707-953-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist