Provider Demographics
NPI:1598264939
Name:REA, MICAH (LMFT)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 RICHMOND BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5853
Mailing Address - Country:US
Mailing Address - Phone:858-245-6449
Mailing Address - Fax:
Practice Address - Street 1:2118 WILLOW PASS RD STE 500
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2414
Practice Address - Country:US
Practice Address - Phone:925-692-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist