Provider Demographics
NPI:1932581527
Name:THOMPSON, DE'ASIA LANEE (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:DE'ASIA
Middle Name:LANEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MS
Other - First Name:DE'ASIA
Other - Middle Name:LANEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:7031 CORPORATE WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4262
Mailing Address - Country:US
Mailing Address - Phone:937-619-9089
Mailing Address - Fax:937-265-6028
Practice Address - Street 1:7031 CORPORATE WAY STE 103
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4262
Practice Address - Country:US
Practice Address - Phone:937-619-6089
Practice Address - Fax:937-265-6028
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.11012681041C0700X
OHI.1700459-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical