Provider Demographics
NPI:1700648482
Name:THOMPSON, TAMARA ALICIA
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ALICIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PARK AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2931
Mailing Address - Country:US
Mailing Address - Phone:301-828-7555
Mailing Address - Fax:
Practice Address - Street 1:104 PARK AVE APT 406
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2931
Practice Address - Country:US
Practice Address - Phone:301-828-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty