Provider Demographics
NPI:1043761935
Name:THOMAS, RACHEL EBONY (LGSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:EBONY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532783
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-2783
Mailing Address - Country:US
Mailing Address - Phone:972-896-9246
Mailing Address - Fax:
Practice Address - Street 1:2310 N HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7387
Practice Address - Country:US
Practice Address - Phone:341-888-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN27703104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program