Provider Demographics
NPI:1790838019
Name:THOMAS, TRACIE L (LPC)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BONHAM CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5502
Mailing Address - Country:US
Mailing Address - Phone:864-844-8019
Mailing Address - Fax:864-328-3210
Practice Address - Street 1:616 BONHAM CT
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-844-8019
Practice Address - Fax:864-328-3210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3461 LPC101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health