Provider Demographics
NPI:1376761171
Name:THOMPSON, ADDIE LASHUN (RASI)
Entity Type:Individual
Prefix:MRS
First Name:ADDIE
Middle Name:LASHUN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-0025
Mailing Address - Country:US
Mailing Address - Phone:661-945-8458
Mailing Address - Fax:661-945-8248
Practice Address - Street 1:44900 60TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7618
Practice Address - Country:US
Practice Address - Phone:661-945-8458
Practice Address - Fax:661-945-8248
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-T0506291612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6767OtherMEDI-CAL