Provider Demographics
NPI:1699085100
Name:THOMPSON, PIERRE WALKER (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:PIERRE
Middle Name:WALKER
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 1:224 S POLLARD AVE
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-2076
Mailing Address - Country:US
Mailing Address - Phone:505-334-7170
Mailing Address - Fax:
Practice Address - Street 1:224 S POLLARD AVE
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2076
Practice Address - Country:US
Practice Address - Phone:505-334-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9917811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical