Provider Demographics
NPI:1841579604
Name:THOMPSON, HARRY (LPC)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3039
Mailing Address - Country:US
Mailing Address - Phone:678-541-5656
Mailing Address - Fax:678-482-0209
Practice Address - Street 1:278 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3039
Practice Address - Country:US
Practice Address - Phone:678-541-5656
Practice Address - Fax:678-482-0209
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional