Healthcare Provider Details

I. General information

NPI: 1265028641
Provider Name (Legal Business Name): CAMILLE TERESA THOMPSON SUDC COUNSELLING INT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 S MAIN ST STE 100
SOUTH SALT LAKE UT
84115-3773
US

IV. Provider business mailing address

3868 W PARACHUTE DR
WEST VALLEY CITY UT
84120-5782
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-4447
  • Fax:
Mailing address:
  • Phone: 385-343-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: