Provider Demographics
NPI:1013425180
Name:THOMPSON, FALENCIO LORENZO (LPCA)
Entity Type:Individual
Prefix:
First Name:FALENCIO
Middle Name:LORENZO
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 HIGH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3914
Mailing Address - Country:US
Mailing Address - Phone:410-778-1099
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:3 CENTERVIEW DR STE 150
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3728
Practice Address - Country:US
Practice Address - Phone:336-834-9664
Practice Address - Fax:336-834-9698
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional