Provider Demographics
NPI:1285143446
Name:THORNABAR, TARHONDA T
Entity type:Individual
Prefix:
First Name:TARHONDA
Middle Name:T
Last Name:THORNABAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 N HUNTER ST APT 7
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1438
Mailing Address - Country:US
Mailing Address - Phone:209-292-4992
Mailing Address - Fax:
Practice Address - Street 1:438 N WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1439
Practice Address - Country:US
Practice Address - Phone:408-254-6828
Practice Address - Fax:408-259-2273
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)