Provider Demographics
NPI:1255613014
Name:THOMPSON, CHARITY ANNE (LCPC)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:ANNE
Other - Last Name:NEVINS AND THEN ZANGORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:4 MEMORIAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6751
Mailing Address - Country:US
Mailing Address - Phone:618-465-8829
Mailing Address - Fax:618-465-5499
Practice Address - Street 1:4 MEMORIAL DR STE 210
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6751
Practice Address - Country:US
Practice Address - Phone:618-465-8829
Practice Address - Fax:618-465-5499
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-007965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional