Provider Demographics
NPI:1649382557
Name:THOMAS, ROBERT LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 LUTHER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1826
Mailing Address - Country:US
Mailing Address - Phone:916-392-5539
Mailing Address - Fax:916-392-5539
Practice Address - Street 1:6885 LUTHER DR
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1826
Practice Address - Country:US
Practice Address - Phone:916-392-5539
Practice Address - Fax:916-392-5539
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health