Provider Demographics
NPI:1205230737
Name:THOMAS ANTHONY, DORETHA
Entity Type:Individual
Prefix:
First Name:DORETHA
Middle Name:
Last Name:THOMAS ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S CENTENNIAL ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5215
Mailing Address - Country:US
Mailing Address - Phone:336-899-1541
Mailing Address - Fax:336-899-1511
Practice Address - Street 1:211 S CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5215
Practice Address - Country:US
Practice Address - Phone:336-899-1541
Practice Address - Fax:336-899-1511
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58-1863838261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)