Provider Demographics
NPI:1952439655
Name:THOMPSON, SHEILA J (MA, LADC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HILLYNDALE RD
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1819
Mailing Address - Country:US
Mailing Address - Phone:860-933-0109
Mailing Address - Fax:
Practice Address - Street 1:2 N EAGLEVILLE RD
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-1710
Practice Address - Country:US
Practice Address - Phone:860-933-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)