Provider Demographics
NPI:1629286729
Name:KEBBA, THOMAS J (MA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:KEBBA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-9231
Mailing Address - Country:US
Mailing Address - Phone:336-202-5419
Mailing Address - Fax:
Practice Address - Street 1:612 PASTEUR DR STE 405
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1120
Practice Address - Country:US
Practice Address - Phone:336-852-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional