Provider Demographics
NPI:1194207738
Name:THOMPSON, LYNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S WHITE ST # 1017
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2773
Mailing Address - Country:US
Mailing Address - Phone:919-276-0762
Mailing Address - Fax:919-200-6584
Practice Address - Street 1:104 S WHITE ST # 1017
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2773
Practice Address - Country:US
Practice Address - Phone:919-276-0762
Practice Address - Fax:919-200-6584
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0137511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical