Individual
ATHENA KOSTICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2403 PROFESSIONAL DR, SANTA ROSA, CA 95403-3007
(707) 544-3295
(707) 544-9011
Mailing address
2403 PROFESSIONAL DR, SANTA ROSA, CA 95403-3007
(707) 544-3295
(707) 544-9011
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490009BN
—
CA
Enumeration date
03/04/2020
Last updated
03/04/2020
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