Provider Demographics
NPI:1326261116
Name:THOMAS, AMANDA MCCOMBS (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MCCOMBS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N CHARLES ST
Mailing Address - Street 2:LOYOLA COLLEGE, LOYOLA CLINICAL CENTERS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2601
Mailing Address - Country:US
Mailing Address - Phone:410-617-2796
Mailing Address - Fax:410-617-2180
Practice Address - Street 1:4501 N CHARLES ST
Practice Address - Street 2:LOYOLA COLLEGE, LOYOLA CLINICAL CENTERS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2601
Practice Address - Country:US
Practice Address - Phone:410-617-2796
Practice Address - Fax:410-617-2180
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02865103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent