Provider Demographics
NPI:1649819897
Name:THOMPSON, CAROLE T (EDS, MA, LPC)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:EDS, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-2203
Mailing Address - Country:US
Mailing Address - Phone:856-323-3100
Mailing Address - Fax:856-863-3501
Practice Address - Street 1:249 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-2203
Practice Address - Country:US
Practice Address - Phone:856-323-3100
Practice Address - Fax:856-863-3501
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00704300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional