Provider Demographics
NPI:1346683620
Name:THOMPSON, CARRIE (LPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 WADE GREEN RD NW
Mailing Address - Street 2:STE 414
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:STE 602
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:678-213-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional