Provider Demographics
NPI:1184964850
Name:THOMPSON, CARMELA (LCGC)
Entity type:Individual
Prefix:MRS
First Name:CARMELA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2619
Mailing Address - Country:US
Mailing Address - Phone:415-637-5617
Mailing Address - Fax:
Practice Address - Street 1:1332 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2619
Practice Address - Country:US
Practice Address - Phone:415-637-5617
Practice Address - Fax:415-664-5492
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000461170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS