Provider Demographics
NPI:1093840449
Name:THOMPSON, MALCOLM ALAN (LPC, LCADC, NCC, SAC)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:ALAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPC, LCADC, NCC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MULBERRY ROW
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2810
Mailing Address - Country:US
Mailing Address - Phone:609-577-2997
Mailing Address - Fax:
Practice Address - Street 1:863 STATE RD.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-577-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00092600101YA0400X
NJ37PC00349100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional