Provider Demographics
NPI:1508491457
Name:THOMPSON, JACQUELINE C (LCMHC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:C
Other - Last Name:CULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-A
Mailing Address - Street 1:PO BOX 745040
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 E WENDOVER AVE STE 400
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1207
Practice Address - Country:US
Practice Address - Phone:336-832-3150
Practice Address - Fax:336-832-3151
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health