Provider Demographics
NPI:1336766799
Name:THURSTON, LESLIE JAMES (CADC, II-CA)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:JAMES
Last Name:THURSTON
Suffix:
Gender:M
Credentials:CADC, II-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 BRICKYARD COVE
Mailing Address - Street 2:
Mailing Address - City:POINT RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3625
Mailing Address - Country:US
Mailing Address - Phone:510-605-6175
Mailing Address - Fax:
Practice Address - Street 1:1160 BRICKYARD COVE RD
Practice Address - Street 2:
Practice Address - City:POINT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4107
Practice Address - Country:US
Practice Address - Phone:510-605-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII33050121171M00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator