Provider Demographics
NPI:1962444893
Name:THOMPSON, JULIUS WALLACE (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:JULIUS
Middle Name:WALLACE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26740 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-2114
Mailing Address - Country:US
Mailing Address - Phone:410-651-4595
Mailing Address - Fax:410-968-0191
Practice Address - Street 1:26740 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-2114
Practice Address - Country:US
Practice Address - Phone:410-651-4595
Practice Address - Fax:410-968-0191
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD817700700Medicaid