Healthcare Provider Details

I. General information

NPI: 1225572308
Provider Name (Legal Business Name): RACHEL CARMICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 CONCORD AVE STE 120
CONCORD CA
94520-5695
US

IV. Provider business mailing address

36 MONTEREY BLVD STE A
SAN FRANCISCO CA
94131-3235
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax: 877-539-7730
Mailing address:
  • Phone: 877-264-6747
  • Fax: 877-539-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12149132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: