Provider Demographics
NPI:1205300183
Name:THOMSON, DANNICA ISABELLE (LCSW 115171)
Entity type:Individual
Prefix:MRS
First Name:DANNICA
Middle Name:ISABELLE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:LCSW 115171
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 TRANSWORLD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-3948
Mailing Address - Country:US
Mailing Address - Phone:209-923-3184
Mailing Address - Fax:
Practice Address - Street 1:2707 TRANSWORLD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-3948
Practice Address - Country:US
Practice Address - Phone:209-464-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1151711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical