Provider Demographics
NPI:1629358809
Name:THOMPSON, MARTHA JANE (LPC; NCC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC; NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 NORTH WAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305
Mailing Address - Country:US
Mailing Address - Phone:912-437-2442
Mailing Address - Fax:
Practice Address - Street 1:1135 NORTH WAY
Practice Address - Street 2:SUITE E
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305
Practice Address - Country:US
Practice Address - Phone:912-437-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional