=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376283499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMELLIA THOMPSON LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2022
-----------------------------------------------------
Last Update Date | 03/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 BEAUVOIR RD STE 3
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39531-4026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-388-2900
-----------------------------------------------------
Fax | 228-388-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 BEAUVOIR RD STE 3
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39531-4026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-388-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | M8141
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------