Healthcare Provider Details

I. General information

NPI: 1255085346
Provider Name (Legal Business Name): THOMIA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 BALM RIVERVIEW RD
RIVERVIEW FL
33569
US

IV. Provider business mailing address

6525 CARRINGTON SKY DR
APOLLO BEACH FL
33572-1732
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-7116
  • Fax: 813-537-8580
Mailing address:
  • Phone: 813-394-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: