Provider Demographics
NPI:1619393063
Name:COMPTON, THERESHA (LMSW)
Entity Type:Individual
Prefix:
First Name:THERESHA
Middle Name:
Last Name:COMPTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 ROLLING BROOK CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1899
Mailing Address - Country:US
Mailing Address - Phone:770-306-7444
Mailing Address - Fax:
Practice Address - Street 1:1605 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2433
Practice Address - Country:US
Practice Address - Phone:404-870-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALMSW003072104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker