Provider Demographics
NPI:1689912842
Name:THOMAS, VIRGINIA (MSC, NCC, LPCMH)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSC, NCC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PORTSIDE CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2400
Mailing Address - Country:US
Mailing Address - Phone:302-838-1553
Mailing Address - Fax:
Practice Address - Street 1:110 PORTSIDE CT
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2400
Practice Address - Country:US
Practice Address - Phone:302-838-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health