Provider Demographics
NPI:1043994973
Name:THOMAS, DREYTON RADLEY
Entity Type:Individual
Prefix:
First Name:DREYTON
Middle Name:RADLEY
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3771
Mailing Address - Country:US
Mailing Address - Phone:504-605-5848
Mailing Address - Fax:
Practice Address - Street 1:4613 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2742
Practice Address - Country:US
Practice Address - Phone:504-544-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician