Healthcare Provider Details

I. General information

NPI: 1477864734
Provider Name (Legal Business Name): THOMPSON CHILD AND FAMILY FOCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 N WENDOVER RD
CHARLOTTE NC
28211
US

IV. Provider business mailing address

6800 SAINT PETERS LN
MATTHEWS NC
28105-8458
US

V. Phone/Fax

Practice location:
  • Phone: 704-376-7180
  • Fax: 704-376-0903
Mailing address:
  • Phone: 704-536-0375
  • Fax: 704-531-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CODY MATTHEW THOMAS
Title or Position: DIRECTOR OF IT
Credential:
Phone: 704-536-0375