Basic Information
| Provider Information | |||||||||
| NPI: | 1154843720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Credential: | MS, MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 WILDER RD | ||||||||
| Address2: | |||||||||
| City: | CHICKAMAUGA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307071736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235961643 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6110 SHALLOWFORD RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374211894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882914357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.