Provider Demographics
NPI:1124730429
Name:THOMPSON, ALICIA MUSGRAVE (DRPH, LMSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MUSGRAVE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DRPH, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5472 E HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9661
Mailing Address - Country:US
Mailing Address - Phone:509-981-8571
Mailing Address - Fax:
Practice Address - Street 1:5472 E HEREFORD RD
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-9661
Practice Address - Country:US
Practice Address - Phone:509-981-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19753104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker