Provider Demographics
NPI:1740537877
Name:THOMPSON, MICHELLE QUICK (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:QUICK
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 HEMLOCK FARMS
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9115
Mailing Address - Country:US
Mailing Address - Phone:703-831-8300
Mailing Address - Fax:703-636-1300
Practice Address - Street 1:8130 BOONE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2666
Practice Address - Country:US
Practice Address - Phone:703-831-8300
Practice Address - Fax:703-636-1300
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0701004806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional