Provider Demographics
NPI:1134401946
Name:THOMPSON, DONTE D
Entity type:Individual
Prefix:
First Name:DONTE
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 PERALTA BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5755
Mailing Address - Country:US
Mailing Address - Phone:510-713-3202
Mailing Address - Fax:510-713-0684
Practice Address - Street 1:4510 PERALTA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5755
Practice Address - Country:US
Practice Address - Phone:510-713-3202
Practice Address - Fax:510-713-0684
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII32670820101YA0400X
CARI-T1105241853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARI-T1105241853OtherBREINING INSTITUTE