Provider Demographics
NPI:1659146678
Name:THOMPSON, MARCUS ALEXANDER (LMSW)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:ALEXANDER
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 BLACK JACK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-5247
Mailing Address - Country:US
Mailing Address - Phone:865-297-7099
Mailing Address - Fax:
Practice Address - Street 1:100 CONCORD ST STE 2A&B
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8328
Practice Address - Country:US
Practice Address - Phone:865-297-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN139041041C0700X
MA2301301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical