Provider Demographics
NPI:1427889690
Name:CARTER THOMPSON, RICKIA NICOLE
Entity type:Individual
Prefix:
First Name:RICKIA
Middle Name:NICOLE
Last Name:CARTER THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 FOOTHILL BLVD APT 312
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2076
Mailing Address - Country:US
Mailing Address - Phone:707-365-7242
Mailing Address - Fax:
Practice Address - Street 1:6475 FOOTHILL BLVD APT 312
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2076
Practice Address - Country:US
Practice Address - Phone:707-365-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24-338370106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician