Provider Demographics
NPI:1982761037
Name:THOMPSON, JOHN DAILEY II (LICSW, MSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAILEY
Last Name:THOMPSON
Suffix:II
Gender:M
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 STRAWBERRY RD
Mailing Address - Street 2:APARTMENT THREE
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2471 ROUTE 21
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9473
Practice Address - Country:US
Practice Address - Phone:304-372-6833
Practice Address - Fax:304-372-6833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009420441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical