Healthcare Provider Details

I. General information

NPI: 1356857403
Provider Name (Legal Business Name): DE'ASIA L. THOMPSON, LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 CORPORATE WAY STE 103
DAYTON OH
45459-4262
US

IV. Provider business mailing address

7031 CORPORATE WAY STE 103
DAYTON OH
45459-4262
US

V. Phone/Fax

Practice location:
  • Phone: 937-619-9089
  • Fax: 937-265-6028
Mailing address:
  • Phone: 937-619-9089
  • Fax: 937-265-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DE'ASIA LANEE THOMPSON
Title or Position: FOUNDER
Credential: LISW-S
Phone: 937-619-9089