Provider Demographics
NPI:1275019119
Name:THOMPKINS, ROLAND
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:THOMPKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E OAK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5834
Mailing Address - Country:US
Mailing Address - Phone:407-483-9520
Mailing Address - Fax:
Practice Address - Street 1:809 E OAK ST STE 106
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-483-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty