Provider Demographics
NPI:1073095741
Name:THOMAS, TAMARA BALDWIN (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:BALDWIN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FIELDING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9062
Mailing Address - Country:US
Mailing Address - Phone:704-724-6206
Mailing Address - Fax:
Practice Address - Street 1:1801 ROZZELLES FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4228
Practice Address - Country:US
Practice Address - Phone:704-446-4683
Practice Address - Fax:704-446-4723
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP113271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical