Provider Demographics
NPI:1235866062
Name:THOMAS, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 REFLECTION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7422
Mailing Address - Country:US
Mailing Address - Phone:770-891-2170
Mailing Address - Fax:770-860-9869
Practice Address - Street 1:2010 REFLECTION CREEK DR
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-7422
Practice Address - Country:US
Practice Address - Phone:770-891-2170
Practice Address - Fax:770-860-9869
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08029571041C0700X
NY070436-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical