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General NPI Number Information
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NPI Number | 1255613014
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Entity Type | Individual
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Provider Name | CHARITY ANNE THOMPSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 4 MEMORIAL DR STE 210
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City | ALTON
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State | IL
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Zip | 62002-6751
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Country | US
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Telephone | 618-465-8829
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Fax | 618-465-5499
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Provider Business Mailing Address
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Address Line | 4 MEMORIAL DR STE 210
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City | ALTON
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State | IL
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Zip | 62002-6751
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Country | US
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Telephone | 618-465-8829
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Fax | 618-465-5499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-007965
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License Number State | IL
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