Provider Demographics
NPI:1518016971
Name:THOMPSON, HOLLY DELL (LMHC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DELL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 CATALINA RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7015
Mailing Address - Country:US
Mailing Address - Phone:904-797-9798
Mailing Address - Fax:
Practice Address - Street 1:8833 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1109
Practice Address - Country:US
Practice Address - Phone:904-641-1888
Practice Address - Fax:904-641-0770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health