Provider Demographics
NPI:1578051413
Name:THOMPSON, MARQUITA LASHAWN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:LASHAWN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 KNICKERBOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3319
Mailing Address - Country:US
Mailing Address - Phone:330-233-4655
Mailing Address - Fax:
Practice Address - Street 1:30 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-3100
Practice Address - Country:US
Practice Address - Phone:513-539-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health