Provider Demographics
NPI:1164677050
Name:THOMAS, CYNTHIA (LLMSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 S KALAMAZOO MALL
Mailing Address - Street 2:STE 250
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4877
Mailing Address - Country:US
Mailing Address - Phone:269-383-1440
Mailing Address - Fax:169-383-9781
Practice Address - Street 1:157 S KALAMAZOO MALL
Practice Address - Street 2:STE 250
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4877
Practice Address - Country:US
Practice Address - Phone:269-383-1440
Practice Address - Fax:169-383-9781
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical