Healthcare Provider Details

I. General information

NPI: 1619144250
Provider Name (Legal Business Name): THOMAS C MESSNER CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 A ST
ANTIOCH CA
94509-2331
US

IV. Provider business mailing address

1408 A ST
ANTIOCH CA
94509-2331
US

V. Phone/Fax

Practice location:
  • Phone: 925-978-2873
  • Fax: 925-757-0411
Mailing address:
  • Phone: 925-978-2873
  • Fax: 925-757-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02-021220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: