Healthcare Provider Details

I. General information

NPI: 1710931415
Provider Name (Legal Business Name): KATHERINE H THOMPSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 MONTICELLO ROAD
COLUMBIA SC
29203
US

IV. Provider business mailing address

4801 MONTICELLO ROAD
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-0151
  • Fax: 803-691-1778
Mailing address:
  • Phone: 803-754-0151
  • Fax: 803-691-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: