Provider Demographics
NPI:1629792775
Name:MICHAEL, ALECIA LEE (RBT)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:LEE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 MILLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3186
Mailing Address - Country:US
Mailing Address - Phone:806-500-6806
Mailing Address - Fax:
Practice Address - Street 1:757 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2529
Practice Address - Country:US
Practice Address - Phone:850-624-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213828106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician