Provider Demographics
NPI:1003255944
Name:ROSETTA CENTER FOR COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:ROSETTA CENTER FOR COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-424-3700
Mailing Address - Street 1:7324 SOUZA CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1521 CORPORATE WAY
Practice Address - Street 2:STE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3891
Practice Address - Country:US
Practice Address - Phone:916-424-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21784103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty