Provider Demographics
NPI:1669043162
Name:THOMPSON, TREVOR NATHAN (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:NATHAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ARBOR HILL PL
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9312
Mailing Address - Country:US
Mailing Address - Phone:919-259-5258
Mailing Address - Fax:
Practice Address - Street 1:47 ARBOR HILL PL
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9312
Practice Address - Country:US
Practice Address - Phone:919-259-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26977101YA0400X
NC16155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)