Provider Demographics
NPI:1063576676
Name:THOMPSON, LEISHA (LPC, LCADC, CJC)
Entity type:Individual
Prefix:
First Name:LEISHA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC, LCADC, CJC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5946
Mailing Address - Country:US
Mailing Address - Phone:732-477-7849
Mailing Address - Fax:
Practice Address - Street 1:445 BRICK BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6080
Practice Address - Country:US
Practice Address - Phone:732-814-3399
Practice Address - Fax:732-785-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00306300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid