Healthcare Provider Details

I. General information

NPI: 1265148894
Provider Name (Legal Business Name): SASHA GAY P THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 34TH AVE STE 701
OCALA FL
34474-8443
US

IV. Provider business mailing address

3200 SW 34TH AVE STE 701
OCALA FL
34474-8443
US

V. Phone/Fax

Practice location:
  • Phone: 877-779-2429
  • Fax:
Mailing address:
  • Phone: 877-779-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20858
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW20858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: