Provider Demographics
NPI:1144716812
Name:THOMPSON, TYRA L (LCPC)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TYRA
Other - Middle Name:L
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:7611 CRAIN HWY SUITE C150
Mailing Address - Street 2:#302
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5208
Mailing Address - Country:US
Mailing Address - Phone:301-442-8111
Mailing Address - Fax:
Practice Address - Street 1:7611 CRAIN HWY SUITE C150 #302
Practice Address - Street 2:#302
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5208
Practice Address - Country:US
Practice Address - Phone:301-442-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional