Provider Demographics
NPI:1013131234
Name:THOMPSON, PRISCILLA STANTON (MA)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:STANTON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHEEP DAVIS RD STE G
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-3706
Mailing Address - Country:US
Mailing Address - Phone:978-500-7762
Mailing Address - Fax:
Practice Address - Street 1:40 PLEASANT ST
Practice Address - Street 2:PILLAR HOUSE RIVERBEND COMMUNITY MENTAL HEALTH
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03302
Practice Address - Country:US
Practice Address - Phone:603-225-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH823101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096721Medicaid