Healthcare Provider Details

I. General information

NPI: 1154925196
Provider Name (Legal Business Name): BENJAMIN DAVID THOMSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LAUREL ST
CULPEPER VA
22701-3910
US

IV. Provider business mailing address

6308 HICKORY RIDGE RD
SPOTSYLVANIA VA
22551-2455
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-5656
  • Fax: 540-808-0591
Mailing address:
  • Phone: 540-623-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701008271
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: