Provider Demographics
NPI:1255791133
Name:CALLAWAY, MICHELL
Entity type:Individual
Prefix:MS
First Name:MICHELL
Middle Name:
Last Name:CALLAWAY
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 1:450 5TH AVE
Mailing Address - Street 2:205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3116
Mailing Address - Country:US
Mailing Address - Phone:415-745-6359
Mailing Address - Fax:
Practice Address - Street 1:915 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4514
Practice Address - Country:US
Practice Address - Phone:415-777-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)