MEDICARE: CHASITY THOMPSON LCSW-BACS

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	10097	LA
2	1041C0700X	Clinical Social Worker	C9488	MS

General Provider Information

NPI Number	:	1770959736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASITY THOMPSON LCSW-BACS

Provider Business Mailing Address
First Line	:	304 N SPRUCE ST
Second Line	:
City	:	VIDALIA
State	:	LA
Zip	:	71373-2738
Country	:	US
Telephone Number	:	318-403-0501
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 JEFFERSON ST
Second Line	:
City	:	NATCHEZ
State	:	MS
Zip	:	39120-3233
Country	:	US
Telephone Number	:	318-403-0501
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/30/2021

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