Provider Demographics
NPI:1063797074
Name:VESSEL-THOMPSON, JILLANA (LCSW)
Entity type:Individual
Prefix:
First Name:JILLANA
Middle Name:
Last Name:VESSEL-THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 MANHATTAN BLVD STE 503A
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5328
Mailing Address - Country:US
Mailing Address - Phone:504-434-0017
Mailing Address - Fax:504-341-1442
Practice Address - Street 1:2439 MANHATTAN BLVD STE 503A
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5328
Practice Address - Country:US
Practice Address - Phone:504-434-0017
Practice Address - Fax:504-341-1442
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48081041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool