Provider Demographics
NPI:1164743811
Name:THOMAS, LEE DAVIS (MA QP)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:DAVIS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 NC HWY 211
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376
Mailing Address - Country:US
Mailing Address - Phone:910-673-8513
Mailing Address - Fax:910-673-8521
Practice Address - Street 1:5228 NC HWY 211
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-673-8513
Practice Address - Fax:910-673-8521
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health