Healthcare Provider Details

I. General information

NPI: 1881104321
Provider Name (Legal Business Name): CELESTE M THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15095 AMARGOSA RD STE 201
VICTORVILLE CA
92394-1875
US

IV. Provider business mailing address

265 SAN JACINTO RIVER RD STE 107
LAKE ELSINORE CA
92530-4400
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-4695
  • Fax: 760-245-4695
Mailing address:
  • Phone: 951-674-9243
  • Fax: 951-674-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116396
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: