Provider Demographics
NPI:1578451662
Name:THOMPSON, RAYMOND (LCADCA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165A CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2719
Mailing Address - Country:US
Mailing Address - Phone:502-407-6650
Mailing Address - Fax:
Practice Address - Street 1:2515 7TH STREET RD STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1070
Practice Address - Country:US
Practice Address - Phone:502-281-7697
Practice Address - Fax:502-234-1973
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275761101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health