Provider Demographics
NPI:1245244128
Name:THOMPSON, CELENA LOUISE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CELENA
Middle Name:LOUISE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WYTHE CREEK RD STE C
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1975
Mailing Address - Country:US
Mailing Address - Phone:757-373-6328
Mailing Address - Fax:757-868-0087
Practice Address - Street 1:177 SQUIRE REACH
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8160
Practice Address - Country:US
Practice Address - Phone:757-934-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188615OtherBCBS VA
VA010242681Medicaid
VA7707037Medicaid
VA7707037Medicaid
VA188615OtherBCBS VA