Provider Demographics
NPI:1629315296
Name:THOMPSON, ANGELICA MARIA (LMFT #102394)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:MARIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT #102394
Other - Prefix:MS
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:PICAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 RAILROAD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-2238
Mailing Address - Country:US
Mailing Address - Phone:925-384-8990
Mailing Address - Fax:
Practice Address - Street 1:430 RAILROAD AVE STE 202
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-2238
Practice Address - Country:US
Practice Address - Phone:925-384-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102394106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty