Healthcare Provider Details

I. General information

NPI: 1073270351
Provider Name (Legal Business Name): YA'LITA WILLIAMS THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CAMELLIA DR
CAPE GIRARDEAU MO
63703-5720
US

IV. Provider business mailing address

24 CAMELLIA DR
CAPE GIRARDEAU MO
63703-5720
US

V. Phone/Fax

Practice location:
  • Phone: 573-591-2873
  • Fax: 573-570-4819
Mailing address:
  • Phone: 573-591-2873
  • Fax: 573-570-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024016862
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: