Provider Demographics
NPI:1528398187
Name:THOMPSON CARTWRIGHT, NICOLE DAWN (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DAWN
Last Name:THOMPSON CARTWRIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DAWN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:453 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1526
Mailing Address - Country:US
Mailing Address - Phone:610-806-3448
Mailing Address - Fax:
Practice Address - Street 1:453 CHERRY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1526
Practice Address - Country:US
Practice Address - Phone:610-806-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional