Provider Demographics
NPI:1295958783
Name:THOMPSON, MARCELLA CAMILLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:CAMILLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 YUBA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1710
Mailing Address - Country:US
Mailing Address - Phone:530-243-0820
Mailing Address - Fax:530-241-9221
Practice Address - Street 1:1720 YUBA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1710
Practice Address - Country:US
Practice Address - Phone:530-243-0820
Practice Address - Fax:530-241-9221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS187721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16690ZMedicare ID - Type Unspecified