=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720564297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA M THOMPSON LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2018
-----------------------------------------------------
Last Update Date | 07/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 E OGLETHORPE HWY
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-368-3502
-----------------------------------------------------
Fax | 912-368-6844
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 COASTAL VILLAGE DR
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31520-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-554-8500
-----------------------------------------------------
Fax | 912-449-7060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC010343
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------