Individual
MISS JEWELL THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, QMHP, CADC, PSS
Contact information
Practice address
436 E 36TH ST, CHARLOTTE, NC 28205-1030
(704) 819-0464
(803) 973-0207
Mailing address
2166 GOLD HILL RD STE 4, FORT MILL, SC 29708-9351
(704) 819-0464
(803) 973-0207
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25110
NC
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
2023-10462-01
NC
Other
Enumeration date
07/24/2015
Last updated
07/27/2024
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