Provider Demographics
NPI:1710742036
Name:THOMPSON PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:THOMPSON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-856-6359
Mailing Address - Street 1:368 S PICKETT ST UNIT 22141
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8322
Mailing Address - Country:US
Mailing Address - Phone:770-856-6359
Mailing Address - Fax:
Practice Address - Street 1:368 S PICKETT ST UNIT 22141
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-8322
Practice Address - Country:US
Practice Address - Phone:770-856-6359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty