Provider Demographics
NPI:1558756064
Name:DEWITT, MILA NICOLE (BCBA)
Entity type:Individual
Prefix:DR
First Name:MILA
Middle Name:NICOLE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2730 SHADELANDS DR BLDG 10
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2538
Mailing Address - Country:US
Mailing Address - Phone:707-363-2384
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST STE 160
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5562
Practice Address - Country:US
Practice Address - Phone:707-399-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst