Provider Demographics
NPI:1073289609
Name:THOMPSON, KATHERINE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SELWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5401
Mailing Address - Country:US
Mailing Address - Phone:910-829-9017
Mailing Address - Fax:
Practice Address - Street 1:109 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5401
Practice Address - Country:US
Practice Address - Phone:910-829-9017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016722101YM0800X
NCA16840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health