MEDICARE: CLARENCE MUHAMMAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1306250881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE MUHAMMAD

Provider Business Mailing Address
First Line	:	8260 CENTER PKWY
Second Line	:	#92
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5907
Country	:	US
Telephone Number	:	916-710-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 SPORTS DR
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1943
Country	:	US
Telephone Number	:	916-575-8851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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