Healthcare Provider Details

I. General information

NPI: 1912205576
Provider Name (Legal Business Name): MICHELLE LYNN THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10430 HARRIS OAK BLVD STE L
CHARLOTTE NC
28269-7513
US

IV. Provider business mailing address

2200 NW 26TH ST
OWATONNA MN
55060-5503
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax: 704-644-2513
Mailing address:
  • Phone: 507-451-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19523
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016561
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: