Provider Demographics
NPI:1164684817
Name:CUESTAS-THOMPSON, ERIC THOMAS (LICSW, LISAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:CUESTAS-THOMPSON
Suffix:
Gender:M
Credentials:LICSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 MARKET ST # 80
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3737
Mailing Address - Country:US
Mailing Address - Phone:520-272-4650
Mailing Address - Fax:253-697-9938
Practice Address - Street 1:748 MARKET ST STE 80
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3737
Practice Address - Country:US
Practice Address - Phone:520-272-4650
Practice Address - Fax:253-697-9938
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10713101YA0400X
1041C0700X
AZLCSW-125021041C0700X
WALW605095441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044698Medicaid
WA2044698Medicaid
WAG8945959Medicare UPIN