Individual provider Active NPI

Sherry Lorraine Thomson, MSW, LCSW

  • Clinical Social Worker
  • Wake Forest, NC
National Provider Identifier
1124153069
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C010637 Issued in NC
Practice address
1906 S Main St Ste 120
Wake Forest, NC 27587-5033
Phone
(195) 621-0809
Fax
(919) 570-3243
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.014840 IL
Clinical Social Worker 1041C0700X C010637 NC Primary

Addresses

Primary practice location

1906 S Main St Ste 120
Wake Forest, NC 27587-5033

Mailing address

1033 Wetterhorn Way
Wendell, NC 27591-7201
Phone (508) 737-5417

Other names 1

  • Stella Thomson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.014840ILMDClinical Social Worker
C010637NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
South Bay Mental Health Center, Inc. PastSince Nov 18, 2019 Accepting new patients
SB Transitional Sub, LLC PastSince May 17, 2021 Accepting new patients
Cloyd Psychological Services, PLLC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1124153069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 WETTERHORN WAY",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "275917201",
            "telephone_number": "508-737-5417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 S MAIN ST STE 120",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875033",
            "telephone_number": "195-621-0809",
            "fax_number": "919-570-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMSON",
        "first_name": "SHERRY",
        "middle_name": "LORRAINE",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.014840",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C010637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STELLA",
            "last_name": "THOMSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.