Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RW4404 | CA |
NPI | 1003190943 |
---|---|
Provider Name | Richard Allen Thomas JR. |
First Address | Long Beach, CA 90802-2847 |
Second Address | Compton, CA 90220-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2011 |
Last Update Date | 10/10/2011 |