Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CA |
NPI | 1003042789 |
---|---|
Provider Name | Mr. Kevin Randolph Thompson |
First Address | Escondido, CA 92025-3439 |
Second Address | Escondido, CA 92025-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 08/06/2009 |