Healthcare Provider Details

I. General information

NPI: 1093362824
Provider Name (Legal Business Name): ASHLAND THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 WATSON RD
CHAPEL HILL NC
27516-7890
US

IV. Provider business mailing address

1206 WATSON RD
CHAPEL HILL NC
27516-7890
US

V. Phone/Fax

Practice location:
  • Phone: 919-923-1311
  • Fax:
Mailing address:
  • Phone: 919-923-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: