Doctor Name: | DWONNA DENISE THOMPSON |
NPI Number: | 1437450541 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LCPC |
License Number: | 180007608 |
Business Practice Address: | 13011 S 104th Ave Palos Park, IL - 604641506 |
Business Phone Number: | 7084483300 |
Business Fax Number: | 7084486972 |
Mailing Address: | 19818 Park Ave, LYNWOOD |
State: | IL |
Postal Code: | 604111394 |
Phone Number: | 7088899897 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2010 |
NPI Last Update Date: | 11/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180007608 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |