Provider Demographics
NPI:1770668295
Name:THOMPSON, CAROLE L (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 HOWE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3314
Mailing Address - Country:US
Mailing Address - Phone:916-212-2932
Mailing Address - Fax:530-620-1047
Practice Address - Street 1:1337 HOWE AVE STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3314
Practice Address - Country:US
Practice Address - Phone:916-212-2932
Practice Address - Fax:530-620-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT41374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT413740OtherBLUE SHIELD
CA364364OtherMHN