| Doctor Name: | ROBERTO THOMPSON |
| NPI Number: | 1538221031 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISAC HS OR GED |
| License Number: | LISAC 11617 |
| Business Practice Address: | 32 Boulevard Del Rey David Nogales, AZ - 856219667 |
| Business Phone Number: | 5202819189 |
| Business Fax Number: | 5202810916 |
| Mailing Address: | 489 N Arroyo Blvd, NOGALES |
| State: | AZ |
| Postal Code: | 856212644 |
| Phone Number: | 5202874713 |
| Fax Number: | 5202879794 |
| NPI Enumeration Date: | 12/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LISAC 11617 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |