Provider Demographics
NPI:1366754160
Name:THOMPSON, KIM R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N ACADIA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-493-9304
Mailing Address - Fax:985-493-9305
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4897
Practice Address - Country:US
Practice Address - Phone:985-493-9304
Practice Address - Fax:985-493-9305
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical