Provider Demographics
NPI:1710643218
Name:THOMPSON, KATIE R (LGPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8837
Mailing Address - Country:US
Mailing Address - Phone:443-650-8480
Mailing Address - Fax:
Practice Address - Street 1:1332 LONDONTOWN BLVD STE 119
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6590
Practice Address - Country:US
Practice Address - Phone:443-650-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12104101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP12130OtherMARYLAND DEPARTMENT OF HEALTH