Healthcare Provider Details

I. General information

NPI: 1215205273
Provider Name (Legal Business Name): MS. STEPHENIE J GARDELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 FRANKLIN BLVD STE 200
SACRAMENTO CA
95823-1865
US

IV. Provider business mailing address

7000 FRANKLIN BLVD STE 200
SACRAMENTO CA
95823-1865
US

V. Phone/Fax

Practice location:
  • Phone: 916-394-9195
  • Fax: 916-392-2827
Mailing address:
  • Phone: 916-394-9195
  • Fax: 916-392-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: