Provider Demographics
NPI:1376112169
Name:THOMPSON, DAIVONNE
Entity Type:Individual
Prefix:MS
First Name:DAIVONNE
Middle Name:
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 1:1642 LOMALAND DR APT 2014
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3811
Mailing Address - Country:US
Mailing Address - Phone:915-494-1634
Mailing Address - Fax:
Practice Address - Street 1:1642 LOMALAND DR APT 2014
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3811
Practice Address - Country:US
Practice Address - Phone:915-494-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)