Provider Demographics
NPI:1992077275
Name:THOMPSON, SANDRA FAYE (LCASA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:FAYE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 RAVENS NEST LN
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-6624
Mailing Address - Country:US
Mailing Address - Phone:516-457-7066
Mailing Address - Fax:
Practice Address - Street 1:99 RAVENS NEST LN
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-6624
Practice Address - Country:US
Practice Address - Phone:516-457-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20271101YA0400X
NY072930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker