Provider Demographics
NPI:1770959736
Name:THOMPSON, CHASITY (LCSW-BACS)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-2738
Mailing Address - Country:US
Mailing Address - Phone:318-403-0501
Mailing Address - Fax:
Practice Address - Street 1:306 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3233
Practice Address - Country:US
Practice Address - Phone:318-403-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100971041C0700X
MSC94881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical