Provider Demographics
NPI:1114339983
Name:THOMAS, AJA (MS, LPC-A, NCC)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 W WENDOVER AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2377
Mailing Address - Country:US
Mailing Address - Phone:336-323-1385
Mailing Address - Fax:336-323-1386
Practice Address - Street 1:3405 W WENDOVER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2377
Practice Address - Country:US
Practice Address - Phone:336-323-1385
Practice Address - Fax:336-323-1386
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10074101YP2500X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool