Provider Demographics
NPI:1407395882
Name:THOMPSON, TERESA (LAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1653
Mailing Address - Country:US
Mailing Address - Phone:443-333-6024
Mailing Address - Fax:
Practice Address - Street 1:3905 CORBIN PL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1653
Practice Address - Country:US
Practice Address - Phone:443-333-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist