Provider Demographics
NPI:1295772481
Name:THOMPSON, WILLIAM THOMAS (EDD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9370
Mailing Address - Country:US
Mailing Address - Phone:336-847-1130
Mailing Address - Fax:
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:SUITE 206
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:919-234-4468
Practice Address - Fax:919-234-4478
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0881103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC680015719OtherRR MEDICARE
NC6000328Medicaid
NC680015719OtherRR MEDICARE