Provider Demographics
NPI:1295376382
Name:THOMPSON, PAIGE MCKENZIE (MS, NCC)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:MCKENZIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRAPE ST APT 303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1455
Mailing Address - Country:US
Mailing Address - Phone:404-825-2355
Mailing Address - Fax:
Practice Address - Street 1:325 CHERRY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2061
Practice Address - Country:US
Practice Address - Phone:215-847-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty