Provider Demographics
NPI:1184343543
Name:THOMPSON, ROBERTA WALLER (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:WALLER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1521
Mailing Address - Country:US
Mailing Address - Phone:804-893-0250
Mailing Address - Fax:
Practice Address - Street 1:7409 TANGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1521
Practice Address - Country:US
Practice Address - Phone:804-893-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional