Provider Demographics
NPI:1558547794
Name:THIGPEN, JACQUES D (CERTIFIED/LICENSED)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:D
Last Name:THIGPEN
Suffix:
Gender:M
Credentials:CERTIFIED/LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BENJAMAN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9352
Mailing Address - Country:US
Mailing Address - Phone:252-558-3139
Mailing Address - Fax:
Practice Address - Street 1:1221 BENJAMAN DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1437
Practice Address - Country:US
Practice Address - Phone:252-558-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC27054103TF0200X
NCJT873203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700510Medicaid