Healthcare Provider Details

I. General information

NPI: 1811891708
Provider Name (Legal Business Name): MILESTONESABA, LLC (DBA MILESTONES)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N MAIN ST STE 1
WALNUT CREEK CA
94596-4653
US

IV. Provider business mailing address

1620 N MAIN ST STE 1
WALNUT CREEK CA
94596-4653
US

V. Phone/Fax

Practice location:
  • Phone: 925-286-6050
  • Fax:
Mailing address:
  • Phone: 925-286-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACIE VICKERS
Title or Position: PRESIDENT
Credential:
Phone: 925-286-6050