Provider Demographics
NPI:1255883849
Name:THOMPSON, ANJULI RAVEN (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:ANJULI
Middle Name:RAVEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AMANDA LN SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3365
Mailing Address - Country:US
Mailing Address - Phone:256-499-2608
Mailing Address - Fax:
Practice Address - Street 1:506 MAIN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1255
Practice Address - Country:US
Practice Address - Phone:256-499-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-29
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional