Provider Demographics
NPI:1548987761
Name:THOMPSON, CHARITY MCKENZIE (RBT)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:MCKENZIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6985 NEXUS CT STE 107
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3186
Mailing Address - Country:US
Mailing Address - Phone:910-493-3999
Mailing Address - Fax:
Practice Address - Street 1:6985 NEXUS CT STE 107
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3186
Practice Address - Country:US
Practice Address - Phone:910-493-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000032567521Medicaid