MEDICARE: MS. TINA NICOLE THOMPSON L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003124	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356515027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TINA NICOLE THOMPSON L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 56
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-0056
Country	:	US
Telephone Number	:	336-270-6896
Fax Number	:	336-270-8066

Provider Business Practice Location Address
First Line	:	154 HUFFMAN MILL RD STE 206
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5113
Country	:	US
Telephone Number	:	336-270-6896
Fax Number	:	336-270-8066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	11/03/2025

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