Provider Demographics
NPI:1417200312
Name:THOMPSON, D'ANNA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:D'ANNA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT
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 874
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-0874
Mailing Address - Country:US
Mailing Address - Phone:949-431-6787
Mailing Address - Fax:949-419-3459
Practice Address - Street 1:17215 STUDEBAKER RD STE 110
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2521
Practice Address - Country:US
Practice Address - Phone:949-431-6787
Practice Address - Fax:949-419-3459
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71238106H00000X
CALMFT97547106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71238OtherIMF
CALMFT97547OtherBBS