Provider Demographics
NPI:1285321356
Name:THOMPSON, SHELIZA (LPCA)
Entity type:Individual
Prefix:
First Name:SHELIZA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SIX LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-8836
Mailing Address - Country:US
Mailing Address - Phone:843-222-3470
Mailing Address - Fax:
Practice Address - Street 1:630 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-5502
Practice Address - Country:US
Practice Address - Phone:843-945-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health