Provider Demographics
NPI:1013430529
Name:THOMPSON, KIMBERLY ARLEEN (LCMHCA, LCAS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ARLEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCMHCA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-2320
Mailing Address - Country:US
Mailing Address - Phone:980-429-2690
Mailing Address - Fax:984-203-9130
Practice Address - Street 1:200 N GROVE ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2320
Practice Address - Country:US
Practice Address - Phone:980-429-2690
Practice Address - Fax:984-203-9130
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-2013101YA0400X
NC26812101YA0400X
NCA16358101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013430529Medicaid