Provider Demographics
NPI:1093870222
Name:THOMPSON, ERICA LESLIE (LMFT, LPCC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LESLIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LESLIE
Other - Last Name:TOLLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, LPCC, LMHC
Mailing Address - Street 1:3033 FIFTH AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5873
Mailing Address - Country:US
Mailing Address - Phone:858-609-9115
Mailing Address - Fax:
Practice Address - Street 1:3033 FIFTH AVE STE 235
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5873
Practice Address - Country:US
Practice Address - Phone:858-609-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA2037101YM0800X
CA89609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicaid