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General NPI Number Information
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NPI Number | 1396493953
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Entity Type | Individual
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Provider Name | NICOLE ANN THOMPSON LCDCIII. 162583
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Gender | Female
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 650 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44906-3702
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Country | US
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Telephone | 833-762-1013
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Fax | 617-591-3893
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Provider Business Mailing Address
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Address Line | 1050 KINGSMILL PKWY
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City | COLUMBUS
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State | OH
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Zip | 43229-1143
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Country | US
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Telephone | 614-907-5434
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Fax | 614-939-2357
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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 | CDCA.141536
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.162583
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License Number State | OH
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