Provider Demographics
NPI:1487242004
Name:THOMPSON, PATRICK ANTHONY SR (AODS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTHONY
Last Name:THOMPSON
Suffix:SR
Gender:M
Credentials:AODS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 52ND ST APT 418
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-8705
Mailing Address - Country:US
Mailing Address - Phone:619-345-1054
Mailing Address - Fax:
Practice Address - Street 1:4321 52ND ST APT 418
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-8705
Practice Address - Country:US
Practice Address - Phone:619-345-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)