Healthcare Provider Details

I. General information

NPI: 1376045591
Provider Name (Legal Business Name): MICHAEL LI ASW124746
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIKEY LI

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 8TH ST STE 201
OAKLAND CA
94607-6527
US

IV. Provider business mailing address

310 8TH ST STE 201
OAKLAND CA
94607-6527
US

V. Phone/Fax

Practice location:
  • Phone: 510-735-3900
  • Fax: 510-735-3941
Mailing address:
  • Phone: 408-735-3900
  • Fax: 510-735-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1347720519
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW124746
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: