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General NPI Number Information
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NPI Number | 1891268074
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Entity Type | Organization
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Legal Business Name | PORTER THOMPSON LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 6201 FLORIO ST
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City | OAKLAND
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State | CA
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Zip | 94618-1333
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Country | US
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Telephone | 415-286-5156
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Fax |
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Provider Business Mailing Address
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Address Line | 6076 CLAREMONT AVE
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City | OAKLAND
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State | CA
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Zip | 94618-1223
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Country | US
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Telephone | 415-286-5156
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. ARIADNE THOMPSON
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Credential | LMFT
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Telephone | 415-286-5156
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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