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General NPI Number Information
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NPI Number | 1073491890
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Entity Type | Individual
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Provider Name | DMITRI EDWARD KOLPACOFF MS
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Gender | Male
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1484 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002-2252
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Country | US
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Telephone | 530-604-4309
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Fax |
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Provider Business Mailing Address
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Address Line | 336 EVERGREEN LN
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City | YREKA
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State | CA
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Zip | 96097-3203
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Country | US
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Telephone | 949-557-9004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APCC20355
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License Number State | CA
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