Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 3188 | LA |
NPI | 1003039439 |
---|---|
Provider Name | Gloria Thompson |
First Address | Zachary, LA 70791 |
Second Address | Zachary, LA 70791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 24/06/2011 |