Provider Demographics
NPI:1720639065
Name:THOMPSON, MELISSA (LCSW- QS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW- QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 ARAGON WAY APT 208
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4756
Mailing Address - Country:US
Mailing Address - Phone:239-671-7950
Mailing Address - Fax:
Practice Address - Street 1:8981 DANIELS CENTER DR STE 209
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0308
Practice Address - Country:US
Practice Address - Phone:239-329-9264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical