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General NPI Number Information
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NPI Number | 1205663879
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Entity Type | Individual
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Provider Name | MIKEALA ANNE-MARIE BRICE
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Gender | Female
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 7224 S RECOVERY RD # 95231
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City | FRENCH CAMP
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State | CA
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Zip | 95231-8901
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Country | US
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Telephone | 209-888-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CONCORD AVE STE 185
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City | CONCORD
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State | CA
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Zip | 94520-5006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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