Provider Demographics
NPI:1497243174
Name:THOMPSON, ANTHONY BATISTE JR (MS, MAR, BCBC, BCCC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:BATISTE
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:MS, MAR, BCBC, BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-0586
Mailing Address - Country:US
Mailing Address - Phone:843-628-0128
Mailing Address - Fax:
Practice Address - Street 1:137 CHAPELWHITE ROAD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:843-628-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-17-31920106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician