Charlos Vernell Thompson, LCSW, PHD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

104085 Issued in CA

Practice address

2215 Portland Ave
Louisville, KY 40212-1033

Phone

(502) 774-8631

Fax

(502) 996-8309

NPI assigned

May 1, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Health Centers of San Diego, Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1114285814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950244",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950244",
            "telephone_number": "812-218-8926",
            "fax_number": "812-218-8930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 PORTLAND AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402121033",
            "telephone_number": "502-774-8631",
            "fax_number": "502-996-8309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "914 E Broadway",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402041037",
            "country_code": "US",
            "telephone_number": "502-589-8085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 6th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921014368",
            "country_code": "US",
            "telephone_number": "619-515-2430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1550 Broadway",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921015713",
            "country_code": "US",
            "telephone_number": "619-515-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "CHARLOS",
        "middle_name": "VERNELL",
        "credential": "LCSW, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2025-09-12",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3534",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "104085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12731602",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Thompson, OTR/L
• Brittany Thompson, PT, DPT
• Brooklyn Taylor Thompson
• Camryn Lane Thompson
• Catherine Elizabeth Thompson, APRN
• Christin Paige Thompson, APRN
• Christina Adele Thompson, APRN
• Christine Thompson, FNP-C
• Christopher Thompson, LPN
• Cierra Thompson, APRN

• Clinical Social Worker in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.