Provider Demographics
NPI:1679699953
Name:THOMPSON, KELVIN LEON (LPC)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:LEON
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1111
Mailing Address - Country:US
Mailing Address - Phone:770-964-3134
Mailing Address - Fax:770-703-2609
Practice Address - Street 1:10 WILSON RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4433
Practice Address - Country:US
Practice Address - Phone:770-506-9575
Practice Address - Fax:770-506-9369
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional