Provider Demographics
NPI:1639209943
Name:THACKER, WILLIAM EDWIN (MFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWIN
Last Name:THACKER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 PARK MARINA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-245-9221
Mailing Address - Fax:530-245-9222
Practice Address - Street 1:353 PARK MARINA CIRCLE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-245-9221
Practice Address - Fax:530-245-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health