Provider Demographics
NPI:1609953793
Name:THOMPSON, SUZANNE BALLARD (MS, MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:BALLARD
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 AURORA LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-8375
Mailing Address - Country:US
Mailing Address - Phone:919-602-5518
Mailing Address - Fax:
Practice Address - Street 1:5816 CREEDMOOR RD
Practice Address - Street 2:STE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:919-602-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102199Medicaid