Provider Demographics
NPI:1912422296
Name:THOMPSON, HENRY C II (EDS)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:C
Last Name:THOMPSON
Suffix:II
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 N CAROUSEL CIR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9002
Mailing Address - Country:US
Mailing Address - Phone:843-469-4041
Mailing Address - Fax:843-486-9544
Practice Address - Street 1:115 DEVON RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9346
Practice Address - Country:US
Practice Address - Phone:843-873-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC506699103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool