Provider Demographics
NPI:1023552619
Name:THOMPSON, RUTH CHEVONNE
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:CHEVONNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:CHEVONNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2495 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8251
Mailing Address - Country:US
Mailing Address - Phone:209-465-1080
Mailing Address - Fax:209-465-2709
Practice Address - Street 1:2495 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8251
Practice Address - Country:US
Practice Address - Phone:209-465-1080
Practice Address - Fax:209-465-2709
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health