Provider Demographics
NPI:1083183990
Name:THOMAS, JAMARI WILLS CENTRELL
Entity Type:Individual
Prefix:
First Name:JAMARI
Middle Name:WILLS CENTRELL
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 1:9332 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-1906
Mailing Address - Country:US
Mailing Address - Phone:510-798-0887
Mailing Address - Fax:
Practice Address - Street 1:9332 VISTA CT
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-1906
Practice Address - Country:US
Practice Address - Phone:510-798-0887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst