Provider Demographics
NPI:1053458133
Name:THOMAS, ANTHONY JOE (LCSW, MSW, MDIV)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCSW, MSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SPRING FOREST RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-9700
Mailing Address - Country:US
Mailing Address - Phone:919-850-9070
Mailing Address - Fax:
Practice Address - Street 1:809 SPRING FOREST RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9700
Practice Address - Country:US
Practice Address - Phone:919-850-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0020811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical