Provider Demographics
NPI:1477786234
Name:THOMAS, LABRENDA
Entity Type:Individual
Prefix:
First Name:LABRENDA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SCARBOROUGH LN
Mailing Address - Street 2:#103
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4859
Mailing Address - Country:US
Mailing Address - Phone:501-837-4526
Mailing Address - Fax:
Practice Address - Street 1:163 SCARBOROUGH LN
Practice Address - Street 2:#103
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4859
Practice Address - Country:US
Practice Address - Phone:501-837-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker