Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1003447327 |
---|---|
Provider Name | Orlando Thompson |
First Address | Savannah, GA 31419-2048 |
Second Address | Savannah, GA 31406-2703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 27/01/2020 |