Provider Demographics
NPI:1043578057
Name:THOMSON, ANGELINE MARIE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:MARIE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:ANGELINE
Other - Middle Name:MARIE
Other - Last Name:MIKELATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 S MELROSE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6641
Mailing Address - Country:US
Mailing Address - Phone:760-213-9233
Mailing Address - Fax:
Practice Address - Street 1:380 S MELROSE DR
Practice Address - Street 2:STE 103
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6641
Practice Address - Country:US
Practice Address - Phone:760-213-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA75920106H00000X
CA98261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program