Provider Demographics
NPI:1932551579
Name:THOMPSON, DEVIN L
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:D
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:933 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3403
Mailing Address - Country:US
Mailing Address - Phone:510-289-1488
Mailing Address - Fax:
Practice Address - Street 1:22646 2ND ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4210
Practice Address - Country:US
Practice Address - Phone:510-247-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)