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1164135711
FANTASIA MICKENS
MONROVIA, CA
NPI
1164135711
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-12-28
Last Update Date
2022-12-28
Business Address
FANTASIA MICKENS
1333 S MAYFLOWER AVE STE 220
MONROVIA, CA 91016-5239
Phone number: 818-241-6780
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Mailing Address
FANTASIA MICKENS
1333 S MAYFLOWER AVE STE 220
MONROVIA, CA 91016-5239
Phone number: 201-780-1589
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