Provider Demographics
NPI:1932466281
Name:THOMPSON, CHRISTINA PUANANI (LADC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:PUANANI
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1885 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE #246
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3489
Mailing Address - Country:US
Mailing Address - Phone:612-326-7578
Mailing Address - Fax:651-647-9147
Practice Address - Street 1:1885 UNIVERSITY AVE W
Practice Address - Street 2:SUITE #246
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3489
Practice Address - Country:US
Practice Address - Phone:612-326-7578
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)