Provider Demographics
NPI:1659522522
Name:THOMAS, SHANE'A PATRICE (LICSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SHANE'A
Middle Name:PATRICE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 COLUMBIA PIKE
Mailing Address - Street 2:APARTMENT 501
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4432
Mailing Address - Country:US
Mailing Address - Phone:757-344-7884
Mailing Address - Fax:
Practice Address - Street 1:2200 COLUMBIA PIKE
Practice Address - Street 2:APARTMENT 501
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4432
Practice Address - Country:US
Practice Address - Phone:757-344-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500787961041C0700X
MD166971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical