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General NPI Number Information
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NPI Number | 1336958248
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Entity Type | Organization
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Legal Business Name | MICHELLE'S MIRACLE RESOURCE FOUNDATION INC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 4719 FOREST PKWY
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City | SACRAMENTO
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State | CA
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Zip | 95823-3139
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Country | US
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Telephone | 916-821-1620
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 231951
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City | SACRAMENTO
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State | CA
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Zip | 95823-0415
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Country | US
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Telephone | 916-821-1620
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. TEMEKA S FULLER
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Credential |
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Telephone | 916-821-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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