Healthcare Provider Details

I. General information

NPI: 1841885290
Provider Name (Legal Business Name): MR. JAMES EDWARD THOMPSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PARK CENTER DR STE 2101701
ORLANDO FL
32835-6235
US

IV. Provider business mailing address

6851 WEISER ST APT 111
ORLANDO FL
32821-8300
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3837
  • Fax: 407-730-3869
Mailing address:
  • Phone: 321-439-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: