| Doctor Name: | RICKY THOMPSON |
| NPI Number: | 1407194640 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | MH 13423 |
| Business Practice Address: | 166 A1a N Ste 216 Ponte Vedra, FL - 320825702 |
| Business Phone Number: | 2293497859 |
| Business Fax Number: | |
| Mailing Address: | 108 Mahogany Bay Dr, SAINT JOHNS |
| State: | FL |
| Postal Code: | 322596948 |
| Phone Number: | 2293497859 |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2013 |
| NPI Last Update Date: | 08/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH 13423 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |