Provider Demographics
NPI:1588966485
Name:THOMPSON, GLORIA ANN (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 N CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9608
Mailing Address - Country:US
Mailing Address - Phone:812-807-4060
Mailing Address - Fax:
Practice Address - Street 1:4350 N CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9608
Practice Address - Country:US
Practice Address - Phone:812-807-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005479A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical