Provider Demographics
NPI:1982596680
Name:THOMPSON, GWENDOLYN (CPSS)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 FALLS OF NEUSE RD # 35-315
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6877
Mailing Address - Country:US
Mailing Address - Phone:919-521-6480
Mailing Address - Fax:
Practice Address - Street 1:6325 FALLS OF NEUSE RD # 35-315
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6877
Practice Address - Country:US
Practice Address - Phone:919-521-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist