Provider Demographics
NPI:1316358625
Name:THOMPSON, CARMELA (LCPC-CC)
Entity Type:Individual
Prefix:MS
First Name:CARMELA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCPC-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ADAMS CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-5503
Mailing Address - Country:US
Mailing Address - Phone:207-491-0343
Mailing Address - Fax:207-645-9556
Practice Address - Street 1:148 ADAMS CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-5503
Practice Address - Country:US
Practice Address - Phone:207-491-0343
Practice Address - Fax:207-645-9556
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health