Provider Demographics
NPI:1356515027
Name:THOMPSON, TINA NICOLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-0056
Mailing Address - Country:US
Mailing Address - Phone:336-270-6896
Mailing Address - Fax:336-270-8066
Practice Address - Street 1:200 N MAIN STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-270-6896
Practice Address - Fax:336-270-8066
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0031241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002354Medicaid
NC2873416CMedicare PIN