Healthcare Provider Details

I. General information

NPI: 1962535518
Provider Name (Legal Business Name): STEVE MACDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CHALLENGER WAY STE 107
SANTA ROSA CA
95407-5423
US

IV. Provider business mailing address

1430 NEOTOMAS AVE
SANTA ROSA CA
95405-7575
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4797
  • Fax:
Mailing address:
  • Phone: 707-565-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC0505890218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: