Healthcare Provider Details

I. General information

NPI: 1124943444
Provider Name (Legal Business Name): MR. TIMOTHY RAY THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 LIVINGSTON LN
CLINTON NC
28328-1513
US

IV. Provider business mailing address

99 ROLLINGWOOD DR
DUNN NC
28334-9614
US

V. Phone/Fax

Practice location:
  • Phone: 919-756-9406
  • Fax:
Mailing address:
  • Phone: 919-756-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: