Provider Demographics
NPI:1124370614
Name:THOMPSON, CAROLINE MAE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 KENDALL ST APT 313
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1487
Mailing Address - Country:US
Mailing Address - Phone:720-620-0126
Mailing Address - Fax:
Practice Address - Street 1:1825 KENDALL ST APT 313
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-1487
Practice Address - Country:US
Practice Address - Phone:720-620-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherNONE TO ENTER