Provider Demographics
NPI:1164969846
Name:THOMPSON, SEON F (LMSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:SEON
Middle Name:F
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HICKORY HALL LN
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-6348
Mailing Address - Country:US
Mailing Address - Phone:810-931-5265
Mailing Address - Fax:
Practice Address - Street 1:G3500 FLUSHING RD STE 244
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4257
Practice Address - Country:US
Practice Address - Phone:813-943-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6801100570104100000X
MI68011050431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker