Provider Demographics
NPI:1104242767
Name:THOMPSON, JANTINA (LCSW)
Entity type:Individual
Prefix:
First Name:JANTINA
Middle Name:
Last Name: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 1:859 WASHINGTON ST # 203
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2704
Mailing Address - Country:US
Mailing Address - Phone:800-501-5085
Mailing Address - Fax:949-561-5392
Practice Address - Street 1:1135 PINE ST STE 21
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0750
Practice Address - Country:US
Practice Address - Phone:530-638-2067
Practice Address - Fax:949-561-5392
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW722931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical