Provider Demographics
NPI:1851877583
Name:THOMPSON, ERIC DARNELL JR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DARNELL
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 SHREWOOD STREET
Mailing Address - Street 2:UNIT 21
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-755-1367
Mailing Address - Fax:
Practice Address - Street 1:2556 SHREWOOD STREET
Practice Address - Street 2:UNIT 21
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-755-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health