Provider Demographics
NPI:1285887547
Name:THOMPSON, KEITH A (LCPC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3158
Mailing Address - Country:US
Mailing Address - Phone:240-464-6166
Mailing Address - Fax:
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:212
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-856-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional