Individual
CHARLENE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
102 E MAIN ST STE 403, URBANA, IL 61801-2744
(217) 305-6063
Mailing address
402 E MICHIGAN AVE APT 11, URBANA, IL 61801-5167
(773) 790-5676
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NONE
—
Enumeration date
12/19/2018
Last updated
12/19/2018
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