Individual
LATINA THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
419 MOYE DR, SANDERSVILLE, GA 31082-7624
(478) 232-3186
Mailing address
125 WEDGEWOOD CT, SANDERSVILLE, GA 31082-8446
(478) 232-3186
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-2120294
—
GA
Enumeration date
08/16/2021
Last updated
08/16/2021
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