Provider Demographics
NPI:1598064685
Name:THOMPSON, AUDRA C (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1357
Mailing Address - Country:US
Mailing Address - Phone:440-202-9640
Mailing Address - Fax:
Practice Address - Street 1:17407 LORAIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4022
Practice Address - Country:US
Practice Address - Phone:440-202-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1303343S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical