Individual
KELLY THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1080 E GUN HILL RD, BRONX, NY 10469-3742
(718) 653-1117
Mailing address
1080 E GUN HILL RD, BRONX, NY 10469-3742
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25104
NY
Other
Enumeration date
06/19/2017
Last updated
06/19/2017
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