Provider Demographics
NPI:1932265170
Name:HARRIS-THOMAS, DUDLEASA STACIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEASA
Middle Name:STACIE
Last Name:HARRIS-THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:HARRIS-THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 20422
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94620-0422
Mailing Address - Country:US
Mailing Address - Phone:510-251-3905
Mailing Address - Fax:
Practice Address - Street 1:969 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4017
Practice Address - Country:US
Practice Address - Phone:510-251-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17974103TC2200X, 103TC0700X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)