Healthcare Provider Details

I. General information

NPI: 1689086456
Provider Name (Legal Business Name): ANGEL MARIE THOMPSON LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 BARRINGTON CT
BOWIE MD
20721-2703
US

IV. Provider business mailing address

1935 BARRINGTON CT
BOWIE MD
20721-2703
US

V. Phone/Fax

Practice location:
  • Phone: 301-326-5383
  • Fax:
Mailing address:
  • Phone: 301-326-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPRC14396
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7925
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: