Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003447772 |
---|---|
Provider Name | Tamaiah Thompson |
First Address | Redondo Beach, CA 90278-3073 |
Second Address | Inglewood, CA 90301-4011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2020 |
Last Update Date | 30/01/2020 |