Provider Demographics
NPI:1275288144
Name:THOMAS, BARBARA L (NCFBPPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NCFBPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2133
Mailing Address - Country:US
Mailing Address - Phone:704-527-7907
Mailing Address - Fax:
Practice Address - Street 1:3900 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2133
Practice Address - Country:US
Practice Address - Phone:704-527-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-2023092Medicaid