Healthcare Provider Details

I. General information

NPI: 1326284761
Provider Name (Legal Business Name): THOMPSON CHILD AND FAMILY FOCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 SAINT PETERS LANE
MATTHEWS NC
28105-8458
US

IV. Provider business mailing address

6800 SAINT PETERS LN
MATTHEWS NC
28105-8458
US

V. Phone/Fax

Practice location:
  • Phone: 704-644-4358
  • Fax: 704-531-9266
Mailing address:
  • Phone: 704-536-0375
  • Fax: 704-531-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHL-060-831
License Number StateNC

VIII. Authorized Official

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