Provider Demographics
NPI:1831536028
Name:THOMAS, JEFFERY EARL SR (LPCC,LAADC)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:EARL
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:LPCC,LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 OCEAN FRONT WALK
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2403
Mailing Address - Country:US
Mailing Address - Phone:310-392-3070
Mailing Address - Fax:310-557-8989
Practice Address - Street 1:503 OCEAN FRONT WALK
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2403
Practice Address - Country:US
Practice Address - Phone:310-392-3070
Practice Address - Fax:310-557-8989
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CALPCC17264101YP2500X
CAAPCC6717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACATC NO. 156320 IIIOtherADDICTION CERTIFICATION BOARD OF CALIFORNIA
CALR10050821OtherLICENSED ADVANCED ALCOHOL ADDICTION COUNSELOR
CAT0912071404OtherREGISTERED ADDICTION SPECIALIST