Provider Demographics
NPI:1912029505
Name:THOMPSON, NANCY LANDERS (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LANDERS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 JOE V. KNOX AVE
Mailing Address - Street 2:SUITE104
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-663-6660
Mailing Address - Fax:704-663-5343
Practice Address - Street 1:132 JOE V. KNOX AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-663-6660
Practice Address - Fax:704-663-5343
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051221041C0700X
GACSW0022121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC005122OtherLCSW LICENSE