Provider Demographics
NPI:1346561214
Name:THOMPSON, ERICA JANELLE (LLMSW)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:JANELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 E 10 MILE RD
Mailing Address - Street 2:APT 3
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1523
Mailing Address - Country:US
Mailing Address - Phone:313-740-4739
Mailing Address - Fax:
Practice Address - Street 1:4925 E 10 MILE RD
Practice Address - Street 2:APT 3
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1523
Practice Address - Country:US
Practice Address - Phone:313-740-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090373104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker