MEDICARE: SHARAHN PATRISE THOMPSON MPA ,BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255002028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARAHN PATRISE THOMPSON MPA ,BS

Provider Business Mailing Address
First Line	:	2308 BIRKSTONE DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-5043
Country	:	US
Telephone Number	:	501-410-7960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 BIRKSTONE DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-5043
Country	:	US
Telephone Number	:	501-410-7960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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