Provider Demographics
NPI:1356941942
Name:THOMPSON, ERIN SARAH
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:SARAH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7314 YELLOWHORN TRL
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7465
Mailing Address - Country:US
Mailing Address - Phone:704-681-3243
Mailing Address - Fax:
Practice Address - Street 1:7314 YELLOWHORN TRL
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7465
Practice Address - Country:US
Practice Address - Phone:704-681-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15611101YP2500X
NCA1561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional