Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | IMH19833 | FL |
Y | 101YS0200X | School Counselor | FL |
NPI | 1255085346 |
---|---|
Provider Name | Thomia Thompson |
First Address | Apollo Beach, FL 33572-1732 |
Second Address | Brandon, FL 33511-8155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2022 |
Last Update Date | 08/02/2022 |