Provider Demographics
NPI:1093212201
Name:THOMAS, BURTON W III (CAP)
Entity Type:Individual
Prefix:MR
First Name:BURTON
Middle Name:W
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RANWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6802
Mailing Address - Country:US
Mailing Address - Phone:386-679-1388
Mailing Address - Fax:
Practice Address - Street 1:17 RANWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6802
Practice Address - Country:US
Practice Address - Phone:386-679-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-010343-2015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)