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NPI Code Detail

MEDICARE: MS. ANNETTE ELEANOR THOMPSON LCAS

MEDICARE: MS. ANNETTE ELEANOR THOMPSON LCAS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorNC
2101YA0400XAddiction (Substance Use Disorder) Counselor2625NC

General Provider Information

NPI Number : 1528319902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNETTE ELEANOR THOMPSON LCAS
Provider Business Mailing Address
First Line : 284 EXECUTIVE PARK DR STE 100
Second Line :
City : CONCORD
State : NC
Zip : 28025-1833
Country : US
Telephone Number : 704-939-1100
Fax Number : 704-939-1173
Provider Business Practice Location Address
First Line : 616 COLONNADE DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-6827
Country : US
Telephone Number : 704-273-3942
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2012
Last Update Date : 12/14/2023

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