Basic Information
| Provider Information | |||||||||
| NPI: | 1699793307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEASTROM | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RADI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LYND WAY | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956203245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076784617 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3353 BRADSHAW RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168544564 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.