Provider Demographics
NPI:1497149033
Name:THOMPSON, BERNADETTE (LPC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:THOMPSON
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3325 SUGARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0625
Mailing Address - Country:US
Mailing Address - Phone:706-469-7213
Mailing Address - Fax:
Practice Address - Street 1:3325 SUGARBERRY DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0625
Practice Address - Country:US
Practice Address - Phone:706-469-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional