Healthcare Provider Details

I. General information

NPI: 1821927294
Provider Name (Legal Business Name): MR. DEMARCUS ANTONIO THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MEETING ST
LANCASTER SC
29720-2326
US

IV. Provider business mailing address

600 W MEETING ST
LANCASTER SC
29720-2326
US

V. Phone/Fax

Practice location:
  • Phone: 980-616-8353
  • Fax:
Mailing address:
  • Phone: 980-616-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP021496
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021496
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: