Provider Demographics
NPI:1457975179
Name:THOMPSON, TERESA (MAAT, LPC, ATR, CBIS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MAAT, LPC, ATR, CBIS
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HOELSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8308 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2108
Mailing Address - Country:US
Mailing Address - Phone:267-918-2582
Mailing Address - Fax:
Practice Address - Street 1:128 CHESTNUT ST STE 404
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3024
Practice Address - Country:US
Practice Address - Phone:215-372-7956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17-070221700000X
PAPC012013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist