Provider Demographics
NPI:1023385259
Name:THOMAS, WANDA L (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SACO ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2856
Mailing Address - Country:US
Mailing Address - Phone:865-373-1050
Mailing Address - Fax:207-591-4159
Practice Address - Street 1:21 SACO ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2856
Practice Address - Country:US
Practice Address - Phone:865-373-1050
Practice Address - Fax:207-591-4159
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC118651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical