Provider Demographics
NPI:1063034403
Name:THOMAS, VICKI J (LPC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 WILLOWSPRING CT
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9101
Mailing Address - Country:US
Mailing Address - Phone:810-869-2570
Mailing Address - Fax:
Practice Address - Street 1:1085 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3421
Practice Address - Country:US
Practice Address - Phone:810-262-2100
Practice Address - Fax:810-230-3376
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI296259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health