Provider Demographics
NPI:1447584578
Name:ELAINE A THOMAS PSYD LLC
Entity Type:Organization
Organization Name:ELAINE A THOMAS PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-216-0460
Mailing Address - Street 1:316 ALEXANDER ST SE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8217
Mailing Address - Country:US
Mailing Address - Phone:770-216-0460
Mailing Address - Fax:678-581-0146
Practice Address - Street 1:316 ALEXANDER ST SE
Practice Address - Street 2:SUITE 6
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8217
Practice Address - Country:US
Practice Address - Phone:770-216-0460
Practice Address - Fax:678-581-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY#2936103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA583311126AMedicaid