Healthcare Provider Details

I. General information

NPI: 1104242767
Provider Name (Legal Business Name): JANTINA THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 PINE ST STE 21
REDDING CA
96001-0750
US

IV. Provider business mailing address

859 WASHINGTON ST # 203
RED BLUFF CA
96080-2704
US

V. Phone/Fax

Practice location:
  • Phone: 530-638-2067
  • Fax: 949-561-5392
Mailing address:
  • Phone: 800-501-5085
  • Fax: 949-561-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW72293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: