Provider Demographics
NPI:1285788778
Name:THOMPSON, JEWEL CARTER (LCSW)
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:CARTER
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 1:3593 ARLINGTON AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3935
Mailing Address - Country:US
Mailing Address - Phone:951-202-2134
Mailing Address - Fax:951-784-5014
Practice Address - Street 1:3593 ARLINGTON AVE
Practice Address - Street 2:SUITE J
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3935
Practice Address - Country:US
Practice Address - Phone:951-202-2134
Practice Address - Fax:951-784-5014
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS164241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical