Provider Demographics
NPI:1194563023
Name:MORONKOLA, MIKAYA
Entity type:Individual
Prefix:
First Name:MIKAYA
Middle Name:
Last Name:MORONKOLA
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 1:17 EMBARCADERO CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5214
Mailing Address - Country:US
Mailing Address - Phone:510-535-1344
Mailing Address - Fax:510-535-1436
Practice Address - Street 1:682 BRIERGATE WAY
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-7245
Practice Address - Country:US
Practice Address - Phone:510-487-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)