Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003302779 |
---|---|
Provider Name | Lisa Jean Marie Thompson |
First Address | Hemet, CA 92543-4335 |
Second Address | Hemet, CA 92543-4335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2018 |
Last Update Date | 20/01/2022 |