Provider Demographics
NPI:1780207035
Name:THOMPSON-MYBURGH, KASHIRA (CDCA)
Entity type:Individual
Prefix:MRS
First Name:KASHIRA
Middle Name:
Last Name:THOMPSON-MYBURGH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2731
Mailing Address - Country:US
Mailing Address - Phone:937-481-5645
Mailing Address - Fax:
Practice Address - Street 1:48 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2731
Practice Address - Country:US
Practice Address - Phone:937-481-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101YA0400XMedicaid