Provider Demographics
NPI:1831603778
Name:THOMPSON, TRACI NICOLE (MA,NCC,LPC)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 METAIRIE HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5048
Mailing Address - Country:US
Mailing Address - Phone:504-261-8040
Mailing Address - Fax:
Practice Address - Street 1:701 PAPWORTH AVE STE 209
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4923
Practice Address - Country:US
Practice Address - Phone:504-261-8040
Practice Address - Fax:504-261-8040
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional