Provider Demographics
NPI:1891938510
Name:THOMAS, DORIS LA VERNE (CADPT 10145)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:LA VERNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CADPT 10145
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 97TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4250
Mailing Address - Country:US
Mailing Address - Phone:310-921-0998
Mailing Address - Fax:
Practice Address - Street 1:11227 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3299
Practice Address - Country:US
Practice Address - Phone:626-444-0704
Practice Address - Fax:626-246-3046
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA121504Other121504