Provider Demographics
NPI:1114405495
Name:THOMAS, ANGELA CHRISTINA (REGISTERED COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CHRISTINA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:REGISTERED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 NEWCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2318
Mailing Address - Country:US
Mailing Address - Phone:415-261-4173
Mailing Address - Fax:
Practice Address - Street 1:1633 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2318
Practice Address - Country:US
Practice Address - Phone:415-261-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8022101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8022Medicaid