Provider Demographics
NPI:1457688368
Name:MUTUA, MWONGELI REBECCA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MWONGELI
Middle Name:REBECCA
Last Name:MUTUA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 BRADSHAW ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2607
Mailing Address - Country:US
Mailing Address - Phone:916-854-4564
Mailing Address - Fax:916-857-1580
Practice Address - Street 1:3353 BRADSHAW ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2607
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:916-857-1580
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)