Healthcare Provider Details

I. General information

NPI: 1558205567
Provider Name (Legal Business Name): JOSEPH M THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4337 CLEVELAND AVE STE A
COLUMBUS OH
43224-5504
US

IV. Provider business mailing address

1610 E 25TH AVE
COLUMBUS OH
43219-1032
US

V. Phone/Fax

Practice location:
  • Phone: 614-348-5793
  • Fax:
Mailing address:
  • Phone: 614-348-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.194774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: