Provider Demographics
NPI:1619469376
Name:THOMPSON, WESLEY LAMONT
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:LAMONT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-2124
Mailing Address - Country:US
Mailing Address - Phone:910-249-6825
Mailing Address - Fax:
Practice Address - Street 1:411 W HAMPTON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3337
Practice Address - Country:US
Practice Address - Phone:843-765-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst