Provider Demographics
NPI:1134656044
Name:THOMPSON, JAMES MONTGOMERY (CDP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MONTGOMERY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 OLD LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5315
Mailing Address - Country:US
Mailing Address - Phone:360-224-8576
Mailing Address - Fax:
Practice Address - Street 1:1960 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-5007
Practice Address - Country:US
Practice Address - Phone:360-856-3481
Practice Address - Fax:360-856-3138
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)