Provider Demographics
NPI:1255421772
Name:THOMPSON, MARY COPPEDGE (LCMHCS, NCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:COPPEDGE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCMHCS, NCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:COPPEDGE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:601B LAUCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5510
Mailing Address - Country:US
Mailing Address - Phone:910-276-7011
Mailing Address - Fax:910-276-7060
Practice Address - Street 1:601 LAUCHWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5510
Practice Address - Country:US
Practice Address - Phone:910-276-7011
Practice Address - Fax:910-276-7060
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4273101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102676Medicaid