Provider Demographics
NPI:1003039439
Name:THOMPSON, GLORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 MAIN STREET
Mailing Address - Street 2:SUITE A #225
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-603-7058
Mailing Address - Fax:225-654-9300
Practice Address - Street 1:5635 MAIN STREET
Practice Address - Street 2:SUITE A #225
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-603-7058
Practice Address - Fax:225-654-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical