Provider Demographics
NPI:1578045589
Name:THOM, TAMARA SMITH (MS LCMHC, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:SMITH
Last Name:THOM
Suffix:
Gender:F
Credentials:MS LCMHC, LCAS
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:DENISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHC, LCAS
Mailing Address - Street 1:2474 WALNUT ST STE 217
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9212
Mailing Address - Country:US
Mailing Address - Phone:910-849-8655
Mailing Address - Fax:
Practice Address - Street 1:2307 CUMBERLAND GAP DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-6940
Practice Address - Country:US
Practice Address - Phone:910-849-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24268101YA0400X
NC13917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)