1124153069 NPI number — MS. SHERRY LORRAINE THOMSON MSW, LCSW

Table of content: MS. SHERRY LORRAINE THOMSON MSW, LCSW (NPI 1124153069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124153069 NPI number — MS. SHERRY LORRAINE THOMSON MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMSON
Provider First Name:
SHERRY
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMSON
Provider Other First Name:
STELLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124153069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1033 WETTERHORN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENDELL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27591-7201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-737-5417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 S MAIN ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKE FOREST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27587-5033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
195-621-0809
Provider Business Practice Location Address Fax Number:
919-570-3243
Provider Enumeration Date:
02/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.014840 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C010637 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)