Basic Information
Provider Information
NPI: 1003141201
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STOLMAKER
FirstName: LAURIE
MiddleName: B.
NamePrefix:  
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC33046CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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