Provider Demographics
NPI:1689142952
Name:MICHAELS, SARIAH KAI
Entity Type:Individual
Prefix:
First Name:SARIAH
Middle Name:KAI
Last Name:MICHAELS
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 1:9480 PRINCETON SQUARE BLVD S APT 304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8306
Mailing Address - Country:US
Mailing Address - Phone:818-518-4026
Mailing Address - Fax:
Practice Address - Street 1:120 EVEREST LN STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4063
Practice Address - Country:US
Practice Address - Phone:904-297-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF7726962103K00000X
FL1689142952106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst