Healthcare Provider Details

I. General information

NPI: 1962325621
Provider Name (Legal Business Name): ROBY CALVIN THOMPSON IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N 3RD ST STE 101
WILMINGTON NC
28401-3474
US

IV. Provider business mailing address

9 CORBETT ST
WRIGHTSVILLE BEACH NC
28480-3125
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-2106
  • Fax:
Mailing address:
  • Phone: 202-486-2315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-31928
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: