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General NPI Number Information
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NPI Number | 1831750116
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Entity Type | Individual
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Provider Name | JEFFREY ALEXANDER THOMPSON
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 309 CATHEDRAL ST STE 200
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City | BALTIMORE
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State | MD
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Zip | 21201-4430
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Country | US
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Telephone | 443-438-7863
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Fax | 443-957-9485
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Provider Business Mailing Address
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Address Line | 8554 BLACK STAR CIR
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City | COLUMBIA
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State | MD
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Zip | 21045-2649
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP9234
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC11071
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License Number State | MD
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