Healthcare Provider Details

I. General information

NPI: 1346965878
Provider Name (Legal Business Name): MADISON DUGGIN MS, AMFT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HOWE AVE BLDG 400-B
SACRAMENTO CA
95825-4731
US

IV. Provider business mailing address

650 HOWE AVE BLDG 400-B
SACRAMENTO CA
95825-4731
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151098
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: