Individual
MS. DIANDRA ALYSSA THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
6042 WASHINGTON AVE APT 1, PHILADELPHIA, PA 19143-2322
(215) 605-3636
Mailing address
6042 WASHINGTON AVE APT 1, PHILADELPHIA, PA 19143-2322
(215) 605-3636
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
SW133272
PA
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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