Provider Demographics
NPI:1750028874
Name:THOMAS, MARCUS (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHICK SPRINGS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4965
Mailing Address - Country:US
Mailing Address - Phone:864-474-5990
Mailing Address - Fax:877-852-8767
Practice Address - Street 1:1 WINDSOR CV STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1833
Practice Address - Country:US
Practice Address - Phone:864-474-5990
Practice Address - Fax:877-852-8767
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty