Provider Demographics
NPI:1003189929
Name:THOMPSON, STACY DELORES (CMT, CLD, CCCE)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:DELORES
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CMT, CLD, CCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 CANARY CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1409
Mailing Address - Country:US
Mailing Address - Phone:248-556-6361
Mailing Address - Fax:
Practice Address - Street 1:1976 CANARY CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1409
Practice Address - Country:US
Practice Address - Phone:248-556-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374JOOOOOX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula