Provider Demographics
NPI:1114246253
Name:THOMPSON CHILD AND FAMILY FOCUS
Entity Type:Organization
Organization Name:THOMPSON CHILD AND FAMILY FOCUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:704-644-4351
Mailing Address - Street 1:6800 SAINT PETERS LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8458
Mailing Address - Country:US
Mailing Address - Phone:704-356-0375
Mailing Address - Fax:704-531-9266
Practice Address - Street 1:6750 SAINT PETERS LANE, SUITE 400
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8458
Practice Address - Country:US
Practice Address - Phone:704-536-0375
Practice Address - Fax:704-531-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
060-1172OtherNC DHHS MENTAL HEALTH LICENSE