Provider Demographics
NPI:1720332067
Name:THOMPSON, SHOLA (LCMHC)
Entity Type:Individual
Prefix:
First Name:SHOLA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10704 GUY R BREWER BLVD
Mailing Address - Street 2:SUITE 7C
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2380
Mailing Address - Country:US
Mailing Address - Phone:718-490-0761
Mailing Address - Fax:
Practice Address - Street 1:10704 GUY R BREWER BLVD
Practice Address - Street 2:SUITE 7C
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2380
Practice Address - Country:US
Practice Address - Phone:718-490-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY005125-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)