Provider Demographics
NPI:1649735374
Name:THOMAS, ANGELA MONIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MONIQUE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 SPACE CENTER BLVD APT 412
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3840
Mailing Address - Country:US
Mailing Address - Phone:281-414-1919
Mailing Address - Fax:
Practice Address - Street 1:19200 SPACE CENTER BLVD APT 412
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3840
Practice Address - Country:US
Practice Address - Phone:281-414-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health