KEONDRE DEJAWN THOMAS
NPI 1407400856
Counselor - Addiction (Substance Use Disorder) in Fresno, CA
Active since July 24, 2019
About Keondre Dejawn Thomas NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KEONDRE DEJAWN THOMAS (NPI 1407400856) is an individual addiction (substance use disorder) provider in Fresno, California and active in the NPI registry since July 2019.
NPPES Registry Identity
NPI1407400856
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameKEONDRE DEJAWN THOMAS
Location Address2772 S MARTIN LUTHER KING BLVDFresno, CA 93727
Mailing Address2772 S Martin Luther King BlvdFresno, CA 93706
Phone(559) 265-4800
Sole ProprietorNo
Enumeration DateJuly 24, 2019
✔ NPI 1407400856 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
2772 S MARTIN LUTHER KING BLVD, Fresno, CA 93727
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1407400856, enumerated as an "individual" on July 24, 2019.
The provider is located at 2772 S MARTIN LUTHER KING BLVD FRESNO, CA 93727 and the phone number is (559) 265-4800.
Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).
