Provider Demographics
NPI:1659995546
Name:THOMAS, MADISON ANN (RBT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 STERNWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-5052
Mailing Address - Country:US
Mailing Address - Phone:904-607-7985
Mailing Address - Fax:
Practice Address - Street 1:6789 SOUTHPOINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8205
Practice Address - Country:US
Practice Address - Phone:904-556-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician