Basic Information
| Provider Information | |||||||||
| NPI: | 1578796264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | LADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1349 | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880621349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 S HUDSON ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880616184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | T-0124641 | NM | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 0127441 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.