Healthcare Provider Details

I. General information

NPI: 1831750116
Provider Name (Legal Business Name): JEFFREY ALEXANDER THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 CATHEDRAL ST STE 200
BALTIMORE MD
21201-4430
US

IV. Provider business mailing address

8554 BLACK STAR CIR
COLUMBIA MD
21045-2649
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7863
  • Fax: 443-957-9485
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP9234
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11071
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: