Provider Demographics
NPI:1124100458
Name:FIKE, MICHELE ALLYNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ALLYNE
Last Name:FIKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 HATHAWAY AVE
Mailing Address - Street 2:460
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-5109
Mailing Address - Country:US
Mailing Address - Phone:562-986-7425
Mailing Address - Fax:
Practice Address - Street 1:1300 S GRAND AVE
Practice Address - Street 2:BLDG B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4434
Practice Address - Country:US
Practice Address - Phone:714-834-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical