Provider Demographics
NPI:1598309171
Name:THOMAS, ANNIE RUTH
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:RUTH
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 1:1159 GLENCARIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-4367
Mailing Address - Country:US
Mailing Address - Phone:904-444-4162
Mailing Address - Fax:
Practice Address - Street 1:1159 GLENCARIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-4367
Practice Address - Country:US
Practice Address - Phone:904-444-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical