Healthcare Provider Details

I. General information

NPI: 1467853788
Provider Name (Legal Business Name): MIQUIA C THOMPSON MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 02/21/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 W HWY 50 # 219
CLERMONT FL
34711-2835
US

IV. Provider business mailing address

877 W MINNEOLA AVE # 120646
CLERMONT FL
34711-2117
US

V. Phone/Fax

Practice location:
  • Phone: 407-588-7466
  • Fax:
Mailing address:
  • Phone: 407-588-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18432
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: