Provider Demographics
NPI:1023063211
Name:THOMPSON, REBEKAH (MA ,HSP-PA)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA ,HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4618
Mailing Address - Country:US
Mailing Address - Phone:704-482-6776
Mailing Address - Fax:704-482-8640
Practice Address - Street 1:616 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4618
Practice Address - Country:US
Practice Address - Phone:704-482-6776
Practice Address - Fax:704-482-8640
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1585103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107130Medicaid
NC141 FWOtherBC/BS
NC6005631Medicaid