Provider Demographics
NPI:1922057785
Name:THOMPSON, RONALD OTHEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:OTHEL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:CAMPOBELLO
Mailing Address - State:SC
Mailing Address - Zip Code:29322-0645
Mailing Address - Country:US
Mailing Address - Phone:864-415-2981
Mailing Address - Fax:864-895-2996
Practice Address - Street 1:124 CHEYENNE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:CAMPOBELLO
Practice Address - State:SC
Practice Address - Zip Code:29322-9198
Practice Address - Country:US
Practice Address - Phone:864-415-2981
Practice Address - Fax:864-895-2996
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC133101YP2500X
SC134106H00000X
GA1440101YP2500X
SC1215103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral