Provider Demographics
NPI:1093703068
Name:THOMPSON, VIRGINIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2312
Mailing Address - Country:US
Mailing Address - Phone:217-544-3143
Mailing Address - Fax:217-544-4436
Practice Address - Street 1:1020 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2312
Practice Address - Country:US
Practice Address - Phone:217-544-3143
Practice Address - Fax:217-544-4436
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical