Healthcare Provider Details

I. General information

NPI: 1760807283
Provider Name (Legal Business Name): MICHAELA L. THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HARRISON ST STE 1100
OAKLAND CA
94612-3648
US

IV. Provider business mailing address

490 43RD ST # 1003
OAKLAND CA
94609-2138
US

V. Phone/Fax

Practice location:
  • Phone: 510-906-8366
  • Fax:
Mailing address:
  • Phone: 510-906-8366
  • Fax: 510-275-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06366
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024030134
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: