Provider Demographics
NPI:1467080010
Name:THOMPSON, WISDOM MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:WISDOM
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 W VERMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6584
Mailing Address - Country:US
Mailing Address - Phone:760-480-2255
Mailing Address - Fax:760-888-8339
Practice Address - Street 1:474 W VERMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6584
Practice Address - Country:US
Practice Address - Phone:760-480-2255
Practice Address - Fax:760-888-8339
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88794101Y00000X, 1041C0700X
CA117182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical