Provider Demographics
NPI:1598949067
Name:THOMPSON, VONETTA COLEMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:VONETTA
Middle Name:COLEMAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VONETTA
Other - Middle Name:MONAE
Other - Last Name:COLEMAN-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 9641
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23670-0641
Mailing Address - Country:US
Mailing Address - Phone:912-312-1452
Mailing Address - Fax:
Practice Address - Street 1:12388 WARWICK BLVD STE 304
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3858
Practice Address - Country:US
Practice Address - Phone:757-768-6148
Practice Address - Fax:757-838-2641
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100009091041C0700X
PACW0170551041C0700X
VA09040081881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical