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NPI Code Detail

MEDICARE: BRIENNA LYN THOMPSON LCSW

MEDICARE: BRIENNA LYN THOMPSON LCSW
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
11041C0700XClinical Social WorkerC015870NC

General Provider Information

NPI Number : 1417266743
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIENNA LYN THOMPSON LCSW
Provider Business Mailing Address
First Line : 147 WESTE AVE
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-5805
Country : US
Telephone Number : 619-368-1774
Fax Number :
Provider Business Practice Location Address
First Line : 1703 COUNTRY CLUB RD STE 204
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-6098
Country : US
Telephone Number : 619-368-1774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2010
Last Update Date : 10/17/2023

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