Provider Demographics
NPI:1003193517
Name:THOMPSON, TERRILA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRILA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10700 BALLANTRAYE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4700
Mailing Address - Country:US
Mailing Address - Phone:540-841-4065
Mailing Address - Fax:540-301-0500
Practice Address - Street 1:10700 BALLANTRAYE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4700
Practice Address - Country:US
Practice Address - Phone:540-841-4065
Practice Address - Fax:540-301-0500
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical