Provider Demographics
NPI:1053556514
Name:THOMPSON, SHIRLEY MARY (MED)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MARY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 POPLAR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3192
Mailing Address - Country:US
Mailing Address - Phone:864-423-6850
Mailing Address - Fax:
Practice Address - Street 1:161 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2819
Practice Address - Country:US
Practice Address - Phone:864-423-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional