Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904007790 | VA |
NPI | 1003193517 |
---|---|
Provider Name | Mrs. Terrila Ann Thompson |
First Address | Fredericksburg, VA 22407-4700 |
Second Address | Fredericksburg, VA 22407-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2011 |
Last Update Date | 11/11/2011 |