Healthcare Provider Details

I. General information

NPI: 1013424662
Provider Name (Legal Business Name): MARIA ANN THOMPSON LCSW 12825
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MORGAN ST
RAYVILLE LA
71269-2576
US

IV. Provider business mailing address

2211 REDWOOD DR
MONROE LA
71201-3631
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-0945
  • Fax:
Mailing address:
  • Phone: 318-372-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12825
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12825
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: