Provider Demographics
NPI:1255085346
Name:THOMPSON, THOMIA
Entity type:Individual
Prefix:
First Name:THOMIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 CARRINGTON SKY DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1732
Mailing Address - Country:US
Mailing Address - Phone:813-394-9924
Mailing Address - Fax:
Practice Address - Street 1:11912 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569
Practice Address - Country:US
Practice Address - Phone:813-444-7116
Practice Address - Fax:813-537-8580
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YS0200X
FLMH20975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool