Healthcare Provider Details

I. General information

NPI: 1013467703
Provider Name (Legal Business Name): CHARLES ZACHARY THOMPSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CAMPUS DR
ABINGDON VA
24210-2589
US

IV. Provider business mailing address

610 CAMPUS DR
ABINGDON VA
24210-2589
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-1550
  • Fax: 276-525-1609
Mailing address:
  • Phone: 276-525-1550
  • Fax: 276-525-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006752
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: