Basic Information
| Provider Information | |||||||||
| NPI: | 1013425180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | FALENCIO | ||||||||
| MiddleName: | LORENZO | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 870 HIGH ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | CHESTERTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216203914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107781099 | ||||||||
| FaxNumber: | 4107787988 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 CENTERVIEW DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274073728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368349664 | ||||||||
| FaxNumber: | 3368349698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A13478 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.