Provider Demographics
NPI:1346699923
Name:THOMAS, JESSICA (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 COOK TRL
Mailing Address - Street 2:
Mailing Address - City:BRANTLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36009-4130
Mailing Address - Country:US
Mailing Address - Phone:334-782-3420
Mailing Address - Fax:334-335-5206
Practice Address - Street 1:1109 COOK TRL
Practice Address - Street 2:
Practice Address - City:BRANTLEY
Practice Address - State:AL
Practice Address - Zip Code:36009-4130
Practice Address - Country:US
Practice Address - Phone:334-782-3420
Practice Address - Fax:334-335-5206
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3554AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health