Healthcare Provider Details

I. General information

NPI: 1700648482
Provider Name (Legal Business Name): MS. TAMARA ALICIA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 CHURCH LN
RANDALLSTOWN MD
21133-4625
US

IV. Provider business mailing address

8616 CHURCH LN
RANDALLSTOWN MD
21133-4625
US

V. Phone/Fax

Practice location:
  • Phone: 301-828-7555
  • Fax:
Mailing address:
  • Phone: 301-828-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: