Provider Demographics
NPI:1053079517
Name:THOMAS, EVELYN MARGARET (LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MARGARET
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:MARGARET
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAS-A,
Mailing Address - Street 1:4437 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4451
Mailing Address - Country:US
Mailing Address - Phone:910-754-4449
Mailing Address - Fax:
Practice Address - Street 1:4437 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4451
Practice Address - Country:US
Practice Address - Phone:910-754-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)