Provider Demographics
NPI:1790126498
Name:THOMAS, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
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 1:367 DELLWOOD RD
Mailing Address - Street 2:BLDG. A STE. 2-A
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3135
Mailing Address - Country:US
Mailing Address - Phone:828-454-6151
Mailing Address - Fax:828-454-6141
Practice Address - Street 1:367 DELLWOOD RD
Practice Address - Street 2:BLDG. A STE. 2-A
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3135
Practice Address - Country:US
Practice Address - Phone:828-454-6151
Practice Address - Fax:828-454-6141
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health