Provider Demographics
NPI:1689184566
Name:TOLBERT, JASON (RADTI)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:RADTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10366 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2546
Mailing Address - Country:US
Mailing Address - Phone:916-368-0700
Mailing Address - Fax:
Practice Address - Street 1:10366 ROCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2546
Practice Address - Country:US
Practice Address - Phone:916-368-0700
Practice Address - Fax:916-368-0700
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1248960417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)