Provider Demographics
NPI:1649597253
Name:THOMPSON, DEBRA W (EDS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 OLD BORING LANE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2495
Mailing Address - Country:US
Mailing Address - Phone:770-928-7300
Mailing Address - Fax:770-928-7558
Practice Address - Street 1:409 OLD BORING LANE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2495
Practice Address - Country:US
Practice Address - Phone:770-928-7300
Practice Address - Fax:770-928-7558
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health