Provider Demographics
NPI:1760807283
Name:THOMPSON, MICHAELA L (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MICHAELA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 43RD ST # 1003
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2138
Mailing Address - Country:US
Mailing Address - Phone:510-906-8366
Mailing Address - Fax:510-275-0462
Practice Address - Street 1:490 43RD ST # 1003
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2138
Practice Address - Country:US
Practice Address - Phone:510-906-8366
Practice Address - Fax:510-275-0462
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA1016491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor