Provider Demographics
NPI:1811913346
Name:THOMPSON, DONNA RAE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:RAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PHOEBE CT SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-5182
Mailing Address - Country:US
Mailing Address - Phone:910-368-5317
Mailing Address - Fax:
Practice Address - Street 1:4303 LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9138
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC58831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical