Provider Demographics
NPI:1174381446
Name:THOMPSON, STEPHANIE (CDCA188284)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CDCA188284
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 GLEN HAVEN CT APT G
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8158
Mailing Address - Country:US
Mailing Address - Phone:567-245-3825
Mailing Address - Fax:
Practice Address - Street 1:9 CHESAPEAKE PLZ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1003
Practice Address - Country:US
Practice Address - Phone:567-588-0400
Practice Address - Fax:419-812-2377
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.188284101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1174381446OtherNPI