Healthcare Provider Details

I. General information

NPI: 1104529072
Provider Name (Legal Business Name): LISA PIGG THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N MAIN ST FL 3
HATTIESBURG MS
39401-3582
US

IV. Provider business mailing address

525 N MAIN ST FL 3
HATTIESBURG MS
39401-3582
US

V. Phone/Fax

Practice location:
  • Phone: 601-699-4080
  • Fax: 603-865-1327
Mailing address:
  • Phone: 601-699-4080
  • Fax: 603-865-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11837
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: