Provider Demographics
NPI:1376973941
Name:THOMAS, LAURA KAYE (BS/ ST)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KAYE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BS/ ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 LEE ROAD 2137
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-1126
Mailing Address - Country:US
Mailing Address - Phone:706-596-5737
Mailing Address - Fax:706-596-5727
Practice Address - Street 1:2100 CORMER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906
Practice Address - Country:US
Practice Address - Phone:706-596-5737
Practice Address - Fax:706-596-5727
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherTRICARE