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Individual
DIANE MARYIE THOMPSON
Active
Individual
DIANE MARYIE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDCC II
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
L15046065
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679797575
MEDI-CAL
CA
01
—
5478
MEDICAL
CA
Enumeration date
08/25/2014
Last updated
11/23/2021
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