| Provider / Organization | NPI | Date Certified |
|---|---|---|
| STACEY KATHLEEN BOTTOMS | 1972156362 | 2019-07-24 |
Stacey Kathleen Bottoms is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1972156362. Registration indicates Stacey Kathleen Bottoms is a provider of services with a specialization in Behavioral Health & Social Service Providers, Marriage & Family Therapist (Marriage & Family Therapist, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Marriage & Family Therapist, Behavioral Health & Social Service Providers)
| Entity Type | Individual |
| Provider Name | Stacey Kathleen Bottoms AMFT |
| Practice Office Address | 1234 EMPIRE ST FAIRFIELD, CA US |
| Practice Office Telephone | 5103171444 |
| Mailing Address | 309 STONYFORD DRIVE VACAVILLE, CA 956874358 US |
| Business Telephone | 7073440699 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 3478 Buskirk Ave Ste 260 | Pleasant Hill, CA 945234358 | 9259431794 |
| 801 Empire St | Fairfield, CA 945335702 | 7074255744 / 7074255162 |
| Code | Practice | License No State |
|---|---|---|
| 106H00000X PRIMARY | Behavioral Health & Social Service Providers Marriage & Family Therapist Marriage & Family Therapist Behavioral Health/Substance Abuse/Psychiatry Marriage & Family Therapist Behavioral Health & Social Service Providers | 122725
CA |