Provider Demographics
NPI:1235570847
Name:THOMAS, LEAH (LLMSW)
Entity Type:Individual
Prefix:
First Name:LEAH
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 1:17193 GOLDWIN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7004
Mailing Address - Country:US
Mailing Address - Phone:313-443-2953
Mailing Address - Fax:
Practice Address - Street 1:17193 GOLDWIN DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7004
Practice Address - Country:US
Practice Address - Phone:313-443-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010947951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical