Provider Demographics
NPI:1912793340
Name:DIMINO, MICHAEL (AMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DIMINO
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 990014
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0014
Mailing Address - Country:US
Mailing Address - Phone:530-276-8326
Mailing Address - Fax:
Practice Address - Street 1:2030 HARTNELL AVE STE D
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-5070
Practice Address - Country:US
Practice Address - Phone:530-255-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT154466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist