Provider Demographics
NPI:1548560626
Name:THOME, TINA M (LPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:THOME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 GREENSEDGE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2535
Mailing Address - Country:US
Mailing Address - Phone:614-425-8830
Mailing Address - Fax:
Practice Address - Street 1:2266 1/2 E MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-3910
Practice Address - Country:US
Practice Address - Phone:614-429-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0700078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional