=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316358625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMELA THOMPSON LCPC-CC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2014
-----------------------------------------------------
Last Update Date | 05/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 ADAMS CIR
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04938-5503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-491-0343
-----------------------------------------------------
Fax | 207-645-9556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 ADAMS CIR
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04938-5503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-491-0343
-----------------------------------------------------
Fax | 207-645-9556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | XL3492
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------