Provider Demographics
NPI:1598844409
Name:SARA THOMPSON MSW LCSW
Entity Type:Organization
Organization Name:SARA THOMPSON MSW LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW LCSW
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:704-366-8500
Mailing Address - Street 1:6845 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3500
Mailing Address - Country:US
Mailing Address - Phone:704-366-8500
Mailing Address - Fax:704-969-1175
Practice Address - Street 1:6845 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3500
Practice Address - Country:US
Practice Address - Phone:704-366-8500
Practice Address - Fax:704-969-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1239041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7917260Medicaid
NC2864372BMedicare ID - Type Unspecified