Healthcare Provider Details

I. General information

NPI: 1174066906
Provider Name (Legal Business Name): THOMAS LEE THOMPSON JR. MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 20TH ST
HUNTINGTON WV
25703-1850
US

IV. Provider business mailing address

1604 HIGHLAND PARK
BARBOURSVILLE WV
25504-1542
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-8700
  • Fax:
Mailing address:
  • Phone: 740-395-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberDP00944886
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: