Provider Demographics
NPI:1538501556
Name:BRISCOE, AKILAH SHANELL
Entity Type:Individual
Prefix:MRS
First Name:AKILAH
Middle Name:SHANELL
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LELAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4961
Mailing Address - Country:US
Mailing Address - Phone:925-439-9628
Mailing Address - Fax:
Practice Address - Street 1:300 EAST LELAND ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4961
Practice Address - Country:US
Practice Address - Phone:925-439-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 62643106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist