Provider Demographics
NPI:1407630809
Name:THOMPSON, LISA DENISE
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DENISE
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 1:280 WINDING RIVER DR UNIT A280
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1930
Mailing Address - Country:US
Mailing Address - Phone:404-803-4645
Mailing Address - Fax:
Practice Address - Street 1:280 WINDING RIVER DR UNIT A
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-1930
Practice Address - Country:US
Practice Address - Phone:404-803-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician