Provider Demographics
NPI:1518390137
Name:THOMAS, PAMELA DIANE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 PROFESSIONAL CT SE STE 103
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7051
Mailing Address - Country:US
Mailing Address - Phone:706-671-9673
Mailing Address - Fax:
Practice Address - Street 1:189 PROFESSIONAL CT SE STE 103
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7051
Practice Address - Country:US
Practice Address - Phone:706-671-9673
Practice Address - Fax:706-842-6921
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009132101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181647AMedicaid