Healthcare Provider Details

I. General information

NPI: 1386706356
Provider Name (Legal Business Name): CARRIE MARIE THOMPSON MSW, LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21947 80TH AVE
MARION MI
49665-8529
US

IV. Provider business mailing address

21947 80TH AVE
MARION MI
49665-8529
US

V. Phone/Fax

Practice location:
  • Phone: 231-832-2247
  • Fax:
Mailing address:
  • Phone: 231-832-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802083222
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: