Provider Demographics
NPI:1578330411
Name:TRAMMELL, REBECCA JEAN (CADC-1)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S HAM LN STE A&B
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3059
Mailing Address - Country:US
Mailing Address - Phone:209-553-0798
Mailing Address - Fax:
Practice Address - Street 1:541 S HAM LN STE A&B
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3059
Practice Address - Country:US
Practice Address - Phone:209-553-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI33750821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)