MEDICARE: KEVIN E THOMPSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701004805	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902123987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN E THOMPSON LPC

Provider Business Mailing Address
First Line	:	8261 OLD TAVERN RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-6806
Country	:	US
Telephone Number	:	540-774-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	8261 OLD TAVERN RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-6806
Country	:	US
Telephone Number	:	540-774-8258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	09/18/2014

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