Healthcare Provider Details

I. General information

NPI: 1811837677
Provider Name (Legal Business Name): STEPHANIE ALEXIS HAMMOND SUDRC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2842 S MARKET ST
REDDING CA
96001-3215
US

IV. Provider business mailing address

2842 S MARKET ST
REDDING CA
96001-3215
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-5920
  • Fax: 530-242-5924
Mailing address:
  • Phone: 530-242-5920
  • Fax: 530-242-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: