Provider Demographics
NPI:1306065222
Name:THOMAS, WILLIAM J (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1455 KETTNER BLVD APT 428
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2482
Mailing Address - Country:US
Mailing Address - Phone:619-548-8213
Mailing Address - Fax:
Practice Address - Street 1:1940 GARNET AVE STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3575
Practice Address - Country:US
Practice Address - Phone:619-548-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA29795103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health