Provider Demographics
NPI:1720135338
Name:THOMPSON, JANE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2631
Mailing Address - Country:US
Mailing Address - Phone:540-533-8952
Mailing Address - Fax:540-667-7683
Practice Address - Street 1:2971 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2631
Practice Address - Country:US
Practice Address - Phone:540-533-8952
Practice Address - Fax:540-667-7683
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA94038101YA0400X
VA0904-0037951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8931551Medicaid
VA190000914Medicare ID - Type Unspecified