Provider Demographics
NPI:1831349026
Name:THOMPSON, KAREY A (LISW-S)
Entity type:Individual
Prefix:
First Name:KAREY
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:KAREY
Other - Middle Name:A
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:1521 N. DETROIT ST
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0817
Mailing Address - Country:US
Mailing Address - Phone:937-465-8065
Mailing Address - Fax:937-465-0442
Practice Address - Street 1:118 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-0670
Practice Address - Country:US
Practice Address - Phone:937-599-1975
Practice Address - Fax:937-599-2769
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0800627104100000X
OHI.1000199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker