Basic Information
| Provider Information | |||||||||
| NPI: | 1568863736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | CALVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | SCII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11308 GWYNNE AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906501815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628523377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1328 2ND ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103946889 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2014 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 67888 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.