Provider Demographics
NPI:1013304922
Name:THOMPSON, CLAUDETTE
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:THOMPSON
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 1:760 E TABOR AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4062
Mailing Address - Country:US
Mailing Address - Phone:707-731-4202
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE B5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3687
Practice Address - Country:US
Practice Address - Phone:925-691-5083
Practice Address - Fax:925-691-5369
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)