Provider Demographics
NPI:1467853788
Name:THOMPSON, MIQUIA C (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:MIQUIA
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 W MINNEOLA AVE # 120646
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2117
Mailing Address - Country:US
Mailing Address - Phone:407-588-7466
Mailing Address - Fax:
Practice Address - Street 1:1064 W HWY 50 # 219
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2835
Practice Address - Country:US
Practice Address - Phone:407-588-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLMH18432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator