Provider Demographics
NPI:1598482424
Name:THOMAS, AMY RANDALL (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RANDALL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEE
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 JAZZ DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4906
Mailing Address - Country:US
Mailing Address - Phone:843-271-4891
Mailing Address - Fax:850-248-2468
Practice Address - Street 1:105 JAZZ DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4906
Practice Address - Country:US
Practice Address - Phone:843-271-4891
Practice Address - Fax:850-248-2468
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW195691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW19569OtherLICENSE