Provider Demographics
NPI:1942868856
Name:THOMPSON, DEJANAIRAH (MSW, LISW)
Entity type:Individual
Prefix:MS
First Name:DEJANAIRAH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 RAINE ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1342
Mailing Address - Country:US
Mailing Address - Phone:614-483-8958
Mailing Address - Fax:
Practice Address - Street 1:11271 STATE ROUTE 762
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9005
Practice Address - Country:US
Practice Address - Phone:614-585-5074
Practice Address - Fax:614-877-7038
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19014751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical