Provider Demographics
NPI:1972048502
Name:DU BOIS, MICHELLE CHERIE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CHERIE
Last Name:DU BOIS
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 1:2114 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2701
Mailing Address - Country:US
Mailing Address - Phone:707-294-8675
Mailing Address - Fax:
Practice Address - Street 1:2114 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2701
Practice Address - Country:US
Practice Address - Phone:707-294-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst