Provider Demographics
NPI:1972849057
Name:THOMPSON, AVIS M
Entity type:Individual
Prefix:MS
First Name:AVIS
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 CARTER ST
Mailing Address - Street 2:APT 301A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-3188
Mailing Address - Country:US
Mailing Address - Phone:415-793-6333
Mailing Address - Fax:
Practice Address - Street 1:522 CARTER ST
Practice Address - Street 2:APT 301A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3188
Practice Address - Country:US
Practice Address - Phone:415-793-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health