Healthcare Provider Details

I. General information

NPI: 1437270774
Provider Name (Legal Business Name): THOMPSON PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E MARION ST
SHELBY NC
28150
US

IV. Provider business mailing address

616 E MARION ST
SHELBY NC
28150-4618
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-6776
  • Fax: 704-482-8640
Mailing address:
  • Phone: 704-482-6776
  • Fax: 704-482-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBEKAH B THOMPSON
Title or Position: OWNER
Credential: HSP-PA
Phone: 704-482-6776