MEDICARE: DR. JACQUES D THIGPEN CERTIFIED/LICENSED

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	101Y00000X	Counselor
2	103TF0200X	Forensic Psychologist	27054	NC
3	174400000X	Specialist	JT873203	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	:	1558547794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUES D THIGPEN CERTIFIED/LICENSED

Provider Business Mailing Address
First Line	:	1221 BENJAMAN DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-9352
Country	:	US
Telephone Number	:	252-558-3139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 BENJAMAN DRIVE
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-1437
Country	:	US
Telephone Number	:	252-558-3139
Fax Number	:

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	03/07/2017

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Directions to “ DR. JACQUES D THIGPEN CERTIFIED/LICENSED” Practice Location

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