Individual
KENNETH THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
708 CORTWRIGHT ST, PONTIAC, MI 48340-2302
(248) 481-9927
(248) 335-6240
Mailing address
102 W YALE AVE, PONTIAC, MI 48340-1862
(248) 431-5341
(248) 335-6240
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
09/09/2014
Last updated
09/09/2014
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