Provider Demographics
NPI:1124555230
Name:THOMPSON, WILLIAM RAYMOND (RECOVERY COACH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RECOVERY COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SUMMERLEE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3059
Mailing Address - Country:US
Mailing Address - Phone:304-877-1074
Mailing Address - Fax:
Practice Address - Street 1:114 SUMMERLEE AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3059
Practice Address - Country:US
Practice Address - Phone:304-877-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit