Healthcare Provider Details

I. General information

NPI: 1811553357
Provider Name (Legal Business Name): DANTE THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

IV. Provider business mailing address

1112 CAPITOL AVE APT 3
SAN FRANCISCO CA
94112-1735
US

V. Phone/Fax

Practice location:
  • Phone: 415-244-4576
  • Fax:
Mailing address:
  • Phone: 415-864-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW123098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: