Healthcare Provider Details

I. General information

NPI: 1710337787
Provider Name (Legal Business Name): MELODY RAE EATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 HURLEY WAY STE 250
SACRAMENTO CA
95825-3253
US

IV. Provider business mailing address

19 BUTMAN AVE
GLOUCESTER MA
01930-1005
US

V. Phone/Fax

Practice location:
  • Phone: 916-922-9217
  • Fax:
Mailing address:
  • Phone: 508-284-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: