Provider Demographics
NPI:1306733670
Name:THOMPSON, GEORGINA PENNELL
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:PENNELL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12954 BUCK BOARD CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6433
Mailing Address - Country:US
Mailing Address - Phone:571-544-0666
Mailing Address - Fax:571-544-0666
Practice Address - Street 1:4001 PRINCE WILLIAM PKWY STE 301
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7667
Practice Address - Country:US
Practice Address - Phone:703-688-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor