Provider Demographics
NPI:1386770089
Name:DEVOLL, MICHELLE R
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:DEVOLL
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 1:33215 MISSION BLVD APT B105
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1451
Mailing Address - Country:US
Mailing Address - Phone:510-475-6220
Mailing Address - Fax:
Practice Address - Street 1:2300 PANAMA ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4662
Practice Address - Country:US
Practice Address - Phone:510-293-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor