Provider Demographics
NPI:1114172293
Name:THOMPSON, BRENDA M (LCPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6231
Mailing Address - Country:US
Mailing Address - Phone:207-319-6369
Mailing Address - Fax:
Practice Address - Street 1:59 FERRY RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250-6231
Practice Address - Country:US
Practice Address - Phone:207-319-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health