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Organization
MILESTONES
Active
Organization
MILESTONES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACIE VICKERS M.S. (EXECUTIVE DIRECTOR)
(925) 286-6050
Entity
Organization
Contact information
Practice address
1620 N MAIN ST, SUITE #1, WALNUT CREEK, CA 94596-4653
(925) 286-6050
(925) 937-6782
Mailing address
1620 N MAIN ST, SUTIE #1, WALNUT CREEK, CA 94596-4653
(925) 286-6050
(925) 937-6782
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
16680
CA
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
11/10/2010
Last updated
05/06/2012
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