Healthcare Provider Details

I. General information

NPI: 1922780832
Provider Name (Legal Business Name): MARY L THOMPSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 MIDLOTHIAN TPKE STE 127
NORTH CHESTERFIELD VA
23235-4776
US

IV. Provider business mailing address

10710 MIDLOTHIAN TPKE STE 127
NORTH CHESTERFIELD VA
23235-4776
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 703-852-7923
Mailing address:
  • Phone: 804-207-6737
  • Fax: 703-852-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016393
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704016255
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704016255
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: