Provider Demographics
NPI:1750503538
Name:THREDE, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:THREDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4000
Mailing Address - Country:US
Mailing Address - Phone:925-809-7920
Mailing Address - Fax:925-809-7928
Practice Address - Street 1:9100 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4000
Practice Address - Country:US
Practice Address - Phone:925-809-7920
Practice Address - Fax:925-809-7928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA070753OtherMASTER PROVIDER NUMBER
CA07533OtherADOL TX ANTIOCH
CA07534OtherDMC ADULT ANTIOCH
CA07553OtherADOL TX BRENTWOOD
CA07557OtherDMC ADOL BRENTWOOD
CA0726OtherMEDI-CAL PROVIDER NUMBER
CA07536OtherDMC ADOL ANTIOCH
CA07556OtherBYRON RANCH
CA0753OtherDRUG MEDI-CAL BILLING NUM
CA07551OtherADULT TX BRENTWOOD
CA07552OtherDMC ADULT BRENTWOOD
CA56682OtherSTAFF BILLING NUMBER
CA070726OtherMASTER PROVIDER NUMBER
CA075531OtherADULT TX ANTIOCH
CA07555OtherDRUG COURT