Provider Demographics
NPI:1750826293
Name:THOMPSON, DION DAVID (CAADC-DMS)
Entity type:Individual
Prefix:
First Name:DION
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CAADC-DMS
Other - Prefix:MR
Other - First Name:DION
Other - Middle Name:DAVID
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAADC-DMS
Mailing Address - Street 1:2267 ZOE AVE SUITE #304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-346-0960
Mailing Address - Fax:
Practice Address - Street 1:2677 ZOE AVE STE 304
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-3699
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1782798101YA0400X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACAADC-DMSOtherMEDI-CAL