Provider Demographics
NPI:1679839724
Name:THOMAS, ANITA WALKER
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:WALKER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S FRENCH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4289
Mailing Address - Country:US
Mailing Address - Phone:407-314-8329
Mailing Address - Fax:
Practice Address - Street 1:2201 S FRENCH AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-4289
Practice Address - Country:US
Practice Address - Phone:407-314-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst