Healthcare Provider Details

I. General information

NPI: 1649511908
Provider Name (Legal Business Name): MICHAEL GARING SUDCC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLOMA WAY
ROSEVILLE CA
95661-4480
US

IV. Provider business mailing address

12183 LOCKSLEY LN STE 101
AUBURN CA
95602-2050
US

V. Phone/Fax

Practice location:
  • Phone: 916-774-6647
  • Fax:
Mailing address:
  • Phone: 530-885-1961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: