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General NPI Number Information
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NPI Number | 1134218696
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Entity Type | Individual
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Provider Name | MR. GREG THOMPSON
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 73 N 2ND AVE STE B
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City | CHULA VISTA
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State | CA
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Zip | 91910-1124
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Country | US
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Telephone | 619-426-4801
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Fax | 616-426-0034
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Provider Business Mailing Address
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Address Line | 1095 N MAIN ST SUITE B
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City | ORANGE
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State | CA
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Zip | 92867-5476
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Country | US
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Telephone | 714-633-0502
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Fax | 714-633-9249
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CICA01630719
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License Number State | CA
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