Individual
ALLISTON DACOSTA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14 FORDHAM RD, ALLSTON, MA 02134-3006
(617) 782-6460
Mailing address
61 COURT ST, MEDFORD, MA 02155-2669
(617) 820-7345
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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