Provider Demographics
NPI:1558530170
Name:FONSECA, THOMAS A (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:FONSECA
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6744
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174-6744
Mailing Address - Country:US
Mailing Address - Phone:504-309-7844
Mailing Address - Fax:504-309-7845
Practice Address - Street 1:3349 RIDGELAKE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3851
Practice Address - Country:US
Practice Address - Phone:985-856-6245
Practice Address - Fax:504-309-7845
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3319101YP2500X
LA1107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist