Provider Demographics
NPI:1437264660
Name:THOMAS, CHARLES E (SSC,CIT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:M
Credentials:SSC,CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 LYNDA LEE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4233
Mailing Address - Country:US
Mailing Address - Phone:318-792-5694
Mailing Address - Fax:
Practice Address - Street 1:401 RAINBOW DR UNIT 35
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6979
Practice Address - Country:US
Practice Address - Phone:318-484-6617
Practice Address - Fax:318-487-5703
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR-1327101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)