Provider Demographics
NPI:1619920055
Name:TODD THOMPSON, MARCIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:TODD THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ALISON
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1106 SCOTCH DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1523
Mailing Address - Country:US
Mailing Address - Phone:704-674-6284
Mailing Address - Fax:980-320-0301
Practice Address - Street 1:1106 SCOTCH DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1523
Practice Address - Country:US
Practice Address - Phone:704-674-6284
Practice Address - Fax:980-320-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003070Medicaid
NC2853544OtherMEDICARE PTAN