Provider Demographics
NPI:1780603696
Name:STOLZENBACH, CHARLES FREDERICK (LMFT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:STOLZENBACH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6919
Mailing Address - Country:US
Mailing Address - Phone:916-874-2409
Mailing Address - Fax:916-874-1296
Practice Address - Street 1:1725 28TH STREET
Practice Address - Street 2:AMH3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6919
Practice Address - Country:US
Practice Address - Phone:916-874-2409
Practice Address - Fax:916-874-1296
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT1825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist