Basic Information
| Provider Information | |||||||||
| NPI: | 1003141201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOLMAKER | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 MONTGOMERY DR | ||||||||
| Address2: | STE 202 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954046629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075232033 | ||||||||
| FaxNumber: | 7075396769 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MONTGOMERY DR | ||||||||
| Address2: | STE 202 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954046629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075232033 | ||||||||
| FaxNumber: | 7075396769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC33046 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.