Healthcare Provider Details

I. General information

NPI: 1659098556
Provider Name (Legal Business Name): CHALISA RAEANNA THOMPSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S PROCTOR ST
TACOMA WA
98405-2047
US

IV. Provider business mailing address

737 FAWCETT AVE
TACOMA WA
98402-5503
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5800
  • Fax:
Mailing address:
  • Phone: 253-396-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61565071
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: