Provider Demographics
NPI:1417278169
Name:THOMPSON CHILD AND FAMILY FOCUS
Entity Type:Organization
Organization Name:THOMPSON CHILD AND FAMILY FOCUS
Other - Org Name:YORK PLACE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PORRAS KANTROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-536-0375
Mailing Address - Street 1:6800 SAINT PETER'S LANE
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7185
Mailing Address - Country:US
Mailing Address - Phone:704-536-0375
Mailing Address - Fax:704-531-9266
Practice Address - Street 1:852 GOLD HILL ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6965
Practice Address - Country:US
Practice Address - Phone:803-548-4044
Practice Address - Fax:803-548-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QM0801X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)