Healthcare Provider Details

I. General information

NPI: 1922057785
Provider Name (Legal Business Name): RONALD OTHEL THOMPSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CHEYENNE RIDGE TRL
CAMPOBELLO SC
29322-9198
US

IV. Provider business mailing address

PO BOX 645
CAMPOBELLO SC
29322-0645
US

V. Phone/Fax

Practice location:
  • Phone: 864-415-2981
  • Fax: 864-895-2996
Mailing address:
  • Phone: 864-415-2981
  • Fax: 864-895-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number133
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1440
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1215
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: