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Individual

CHARLOS VERNELL THOMPSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW, PHD

Contact information

Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
(502) 996-8309
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(812) 218-8926
(812) 218-8930

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
104085
CA
1041C0700X
Clinical Social Worker
3534
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12731602
KY
Enumeration date
05/01/2012
Last updated
09/12/2025
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