Healthcare Provider Details

I. General information

NPI: 1396822292
Provider Name (Legal Business Name): CHARLES E. THIGPEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MANOR ST
MARION AR
72364-1936
US

IV. Provider business mailing address

2470 CAPEWOOD DR
MEMPHIS TN
38127-8332
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-6818
  • Fax: 870-739-1970
Mailing address:
  • Phone: 901-358-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number591-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: