Provider Demographics
NPI:1225627854
Name:THOMPSON, MEGAN ALYCEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALYCEN
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 1:5061 WESTERN BLVD APT 2G
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6893
Mailing Address - Country:US
Mailing Address - Phone:910-787-0359
Mailing Address - Fax:
Practice Address - Street 1:410 NEW BRIDGE ST STE 9B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4759
Practice Address - Country:US
Practice Address - Phone:910-787-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0161601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical