Provider Demographics
NPI:1538907126
Name:VONETTA THOMPSON
Entity type:Organization
Organization Name:VONETTA THOMPSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VONETTA
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCSW
Authorized Official - Phone:915-666-4904
Mailing Address - Street 1:112 SETTLERS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1740
Mailing Address - Country:US
Mailing Address - Phone:757-768-6148
Mailing Address - Fax:757-800-0188
Practice Address - Street 1:1702 TODDS LN STE 385
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3212
Practice Address - Country:US
Practice Address - Phone:757-768-6288
Practice Address - Fax:757-800-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty