Healthcare Provider Details

I. General information

NPI: 1831504604
Provider Name (Legal Business Name): STEPHANIE BUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 CREEKSIDE DR APT 18
WALNUT CREEK CA
94596-5779
US

IV. Provider business mailing address

1390 CREEKSIDE DR APT 18
WALNUT CREEK CA
94596-5779
US

V. Phone/Fax

Practice location:
  • Phone: 925-360-7694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: