Individual
MIRANDA NICOLE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 PATRICK STREET PLZ, CHARLESTON, WV 25387-2444
(304) 233-3200
Mailing address
303 PENNSYLVANIA AVE APT A, CHARLESTON, WV 25302-2359
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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