Provider Demographics
NPI:1194002683
Name:MACIAS, MICHELLE DENISE (BA PSYCH, CD SPECI)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:MACIAS
Suffix:
Gender:F
Credentials:BA PSYCH, CD SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:222 E MAIN ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2361
Mailing Address - Country:US
Mailing Address - Phone:760-255-1496
Mailing Address - Fax:760-255-2542
Practice Address - Street 1:222 E MAIN ST
Practice Address - Street 2:SUITE 117
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2361
Practice Address - Country:US
Practice Address - Phone:760-255-1496
Practice Address - Fax:760-255-2542
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health