Provider Demographics
NPI:1790208122
Name:THOMPSON CHILD THERAPY
Entity Type:Organization
Organization Name:THOMPSON CHILD THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (DBA)
Authorized Official - Prefix:
Authorized Official - First Name:MEGGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, RPT
Authorized Official - Phone:301-710-9532
Mailing Address - Street 1:106 E RIDGEVILLE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5232
Mailing Address - Country:US
Mailing Address - Phone:301-710-9532
Mailing Address - Fax:
Practice Address - Street 1:106 E RIDGEVILLE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5232
Practice Address - Country:US
Practice Address - Phone:301-710-9532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty