Basic Information
| Provider Information | |||||||||
| NPI: | 1922639277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | THERESE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3027 ROUNDTREE BLVD APT C3 | ||||||||
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| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481974882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103472428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2700 HAMLIN BLVD | ||||||||
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| City: | INKSTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481412206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135615100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2020 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801106373 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.