Provider Demographics
NPI:1750654620
Name:WEATHERS, THOMAS ANTHONY (LCAS/LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:LCAS/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28332-0092
Mailing Address - Country:US
Mailing Address - Phone:910-876-3228
Mailing Address - Fax:855-420-6032
Practice Address - Street 1:1776 WELLINGTON AVE STE 2
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6075
Practice Address - Country:US
Practice Address - Phone:910-799-5452
Practice Address - Fax:855-420-6032
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1984101YA0400X
NCC008509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1984OtherSUBSTANCE ABUSE PRACTICE BOARD
NCC008509OtherNATIONAL ASSOCIATION OF SOCIAL WORKERS