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General NPI Number Information
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NPI Number | 1700255205
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Entity Type | Individual
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Provider Name | INA THOMPSON MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 272 MEDICAL PARK BOULEVARD
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-733-0129
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Fax | 804-518-1341
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Provider Business Mailing Address
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Address Line | 3811 BREVARD CT
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23834-1663
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Country | US
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Telephone | 804-605-2528
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Fax | 804-518-1341
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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 | 0701006300
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License Number State | VA
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