Provider Demographics
NPI:1609403955
Name:THOMPSON, ASHLEY TONIQUE (RES REHAB 31)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TONIQUE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RES REHAB 31
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 ELINORE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1722
Mailing Address - Country:US
Mailing Address - Phone:443-473-5771
Mailing Address - Fax:
Practice Address - Street 1:2799 1/2 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4921
Practice Address - Country:US
Practice Address - Phone:443-473-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility