Provider Demographics
NPI:1912121211
Name:THOMPSON, DEBORAH D (MA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 PRESIDENTIAL CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3521
Mailing Address - Country:US
Mailing Address - Phone:239-433-0071
Mailing Address - Fax:239-433-3137
Practice Address - Street 1:6226 PRESIDENTIAL CT
Practice Address - Street 2:SUITE D
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3521
Practice Address - Country:US
Practice Address - Phone:239-433-0071
Practice Address - Fax:239-433-3137
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
FLMH5402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health