Healthcare Provider Details

I. General information

NPI: 1255994497
Provider Name (Legal Business Name): SYRETHA RENA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 HILL AVE APT A201
TOLEDO OH
43615-5478
US

IV. Provider business mailing address

4404 HILL AVE APT A201
TOLEDO OH
43615-5478
US

V. Phone/Fax

Practice location:
  • Phone: 567-225-8987
  • Fax:
Mailing address:
  • Phone: 567-225-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: