Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003285115 |
---|---|
Provider Name | Ms. Angela Thompson |
First Address | Detroit, MI 48224-2139 |
Second Address | Detroit, MI 48224-2139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2015 |
Last Update Date | 18/09/2015 |