Provider Demographics
NPI:1083898092
Name:THOMPSON, DAVID HENRY JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HENRY
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21512 RIPPLEMEAD DR
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882-1840
Mailing Address - Country:US
Mailing Address - Phone:410-800-4226
Mailing Address - Fax:301-596-2745
Practice Address - Street 1:2641 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4518
Practice Address - Country:US
Practice Address - Phone:410-800-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212150600Medicaid