Healthcare Provider Details

I. General information

NPI: 1982931358
Provider Name (Legal Business Name): MM UNLIMITED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 ENGLE RD SUITE 200
CARMICHAEL CA
95608-3091
US

IV. Provider business mailing address

3811 FLORIN RD SUITE 26
SACRAMENTO CA
95823-1800
US

V. Phone/Fax

Practice location:
  • Phone: 916-421-1184
  • Fax: 916-421-1188
Mailing address:
  • Phone: 916-421-1184
  • Fax: 916-421-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA S JOHNSON
Title or Position: PROGRAM ADMINSITRATOR
Credential:
Phone: 916-421-1184