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Individual

MS. DANIELLE THOMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMFT

Contact information

Practice address
3292 COUNTY ROAD 220, MIDDLEBURG, FL 32068-4357
(904) 278-5644
(904) 278-5659
Mailing address
1726 KINGSLEY AVE STE 2, ORANGE PARK, FL 32073-4411
(904) 278-5644
(904) 278-5659

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT 2259
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MT 2259
IN PROCESS OF MEDICAID #
FL
Enumeration date
08/09/2007
Last updated
08/09/2007
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