Provider Demographics
NPI:1144237504
Name:ANSBRO, THOMAS C (PSYD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:ANSBRO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 FOX TRCE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-9724
Mailing Address - Country:US
Mailing Address - Phone:704-639-0745
Mailing Address - Fax:
Practice Address - Street 1:128 N MERRITT AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2636
Practice Address - Country:US
Practice Address - Phone:704-216-0283
Practice Address - Fax:704-216-0286
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000737Medicaid
NC2816247BMedicare ID - Type Unspecified