Provider Demographics
NPI:1356460539
Name:THOMPSON, VERNON THOMAS (EDD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:THOMAS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 KILAUEA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5308
Mailing Address - Country:US
Mailing Address - Phone:808-732-1031
Mailing Address - Fax:
Practice Address - Street 1:4747 KILAUEA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5308
Practice Address - Country:US
Practice Address - Phone:808-732-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI71103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000057356OtherHMSA QUEST
HI00057356OtherHMSA
HI15034601Medicaid
HI4550OtherALOHACARE
HIPSY#71OtherUHA
HI1507956OtherTRICARE
HIPSY#71OtherAETNA