Provider Demographics
NPI:1710073028
Name:WARD, THOMAS A
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 ELDON BAKER DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1923
Mailing Address - Country:US
Mailing Address - Phone:810-744-3600
Mailing Address - Fax:
Practice Address - Street 1:32932 WARREN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3095
Practice Address - Country:US
Practice Address - Phone:313-562-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-01-05
Deactivation Date:2010-01-08
Deactivation Code:
Reactivation Date:2011-01-05
Provider Licenses
StateLicense IDTaxonomies
MI6801016027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker