Provider Demographics
NPI:1942012489
Name:THOMPSON, ANGELA B
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:B
Other - Last Name:STALLWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 JANUARY AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1953
Mailing Address - Country:US
Mailing Address - Phone:314-967-9023
Mailing Address - Fax:
Practice Address - Street 1:420 JANUARY AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1953
Practice Address - Country:US
Practice Address - Phone:314-967-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19027101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor