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General NPI Number Information
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NPI Number | 1356930671
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Entity Type | Individual
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Provider Name | DEMETRA THOMPSON LPC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 513 MAIN ST
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-5329
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Country | US
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Telephone | 501-777-5969
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Fax |
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Provider Business Mailing Address
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Address Line | 513 MAIN ST
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-5329
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Country | US
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Telephone | 501-777-5969
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2012186
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2310011
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License Number State | AR
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