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General NPI Number Information
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NPI Number | 1457061129
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Entity Type | Individual
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Provider Name | KEVIN SHEVON THOMAS
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Gender | Male
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 600 W SANTA ANA BLVD STE 109
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City | SANTA ANA
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State | CA
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Zip | 92701-4582
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Country | US
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Telephone | 714-667-7926
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 W WILLIAMS ST BLDG 2
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City | LONG BEACH
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State | CA
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Zip | 90810-3636
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Country | US
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Telephone | 562-388-8118
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Fax | 562-388-8117
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12392
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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