Provider Demographics
NPI:1346787876
Name:THOMAS, TAWONIA (MA, BSW)
Entity Type:Individual
Prefix:
First Name:TAWONIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, BSW
Other - Prefix:
Other - First Name:TAWONIA
Other - Middle Name:ROSS
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BSW
Mailing Address - Street 1:113 PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-5906
Mailing Address - Country:US
Mailing Address - Phone:843-495-9198
Mailing Address - Fax:
Practice Address - Street 1:2436 WILLWOOD DR
Practice Address - Street 2:APT. C
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3904
Practice Address - Country:US
Practice Address - Phone:843-495-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health