Provider Demographics
NPI:1437534914
Name:THOMPSON, JEWELL (MS, MHP, CALOCUS)
Entity Type:Individual
Prefix:MISS
First Name:JEWELL
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, MHP, CALOCUS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 HIGHWAY 160 W STE 101-304
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8009
Mailing Address - Country:US
Mailing Address - Phone:704-819-0464
Mailing Address - Fax:803-973-0207
Practice Address - Street 1:2166 GOLD HILL RD STE 4
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9351
Practice Address - Country:US
Practice Address - Phone:704-819-0464
Practice Address - Fax:803-973-0207
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional