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General NPI Number Information
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NPI Number | 1003255944
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Entity Type | Organization
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Legal Business Name | ROSETTA CENTER FOR COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 1521 CORPORATE WAY STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95831-3891
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Country | US
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Telephone | 916-424-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 7324 SOUZA CIR
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City | SACRAMENTO
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State | CA
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Zip | 95831-4737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIFFANY ROSE MIMMS
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Credential | PH.D.
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Telephone | 916-424-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 21784
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License Number State | CA
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